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Snakes and ladders path to surgery

by Will Venn

An xray of a knee.Patients seeking hip and knee replacement surgery commonly face a ‘snakes and ladders’ type game in trying to progress their way through waiting lists and times to start their treatment in South Australian public hospitals.

This is one of the findings of a study by UniSA’s School of Health Sciences which identified what barriers there are to efficient delivery of elective surgery in public hospitals and which concluded that targeted reforms to improve waiting times required a mix of internal and external strategies.

Dr Julie Walters.Dr Julie Walters (pictured right), course coordinator for Advanced Physiotherapy Practice and Advanced Hospital Care at UniSA, led the research, observing administrative processes and interviewing hospital staff over the period of a year, in four large South Australian public hospitals.

“Waiting lists and waiting times for surgery are controversial, associated with frequent reforms and negative emotive headlines. We know from existing literature and anecdotal reports that individuals frequently experience lengthy delays before receiving elective surgery,” Dr Walters said.

“This paper adds weight to the argument that some inefficiencies exist within elective surgery systems, and identifies specific barriers to the delivery of total hip and total knee-replacement surgery in South Australian public hospitals.”

Inadequate resources were cited as the most prominent barrier, with a shortage of appointments available in outpatient, auxiliary and pre-admission clinics. Interviews with hospital staff also revealed that a high number of cancellations led to significant repetition of administrative tasks.

External factors relating to the timing and quality of referrals from GPs, including the perceived practice of referring a single patient to multiple hospitals, or the overstating of a patient’s symptoms in an effort to prioritise earlier surgery treatment, were also relayed in interviews during research.

“Given the complexity of the elective surgery system, it is not surprising that single-item reforms such as a once-off injection of funds, have not created lasting reductions in waiting times,” Dr Walters said.

“Multifaceted, whole-system reforms that include a combination of steps to streamline internal administrative processes and improve communication, and external changes to the way referrals are made and managed may be more successful, and have shown promising short-term improvements in waiting lists for other medical disciplines.”