Patients search website for surgery
Waiting time information may not meet the needs of patients and doctors seeking access to surgical services, according to a survey in the latest issue of the Medical Journal of Australia.
The survey, led by Mr David Cromwell, Senior Research Fellow, and colleagues from the University of Wollongong, reviewed websites that provide waiting time information services and assessed how they meet the users' information needs.
The six government websites, selected from English speaking countries, were judged to encourage general practitioners and patients to use the statistics to avoid surgical units with long waiting times.
Mr Cromwell described the overall level of guidance for users of the web-sites was poor.
Although sites give definitions of the waiting list terms used, they provide inadequate advice about what might constitute a real difference in waiting times between surgeons or specialties.
Users could consider the statistics presented by the sites as predicting how long they might wait, which would be misleading. But just one reviewed site stated that the statistics were only intended as a guide.
"This lack of direction might lead users to draw inappropriate conclusions … Statements are needed about how the information should and should not be used," Mr Cromwell said.
The survey highlights three interpretations of waiting time information. GPs and patients might seek information that:
1 Predicts how long a patient might expect to wait for admission to a particular surgical unit;
2 Identifies units at which a patient will wait different lengths of time; or
3 Identifies units at which a patient will wait an acceptable time.
Mr Cromwell said that services should just support interpretation 3, because it encourages change in referral patterns only when there is a problem.
The researchers conclude that waiting time data currently published on the Web and elsewhere are only suitable for informing doctor referral or patient decision-making in a few situations, such as when used to avoid long waiting times. Otherwise, until better guidance is provided, they should be used with caution.
In an editorial in the same issue of the MJA, Associate Professor Neil Boyce, Manager of Intellectual Capital at the Australian Red Cross Blood Service in South Melbourne, suggests that surgical waiting times are just one example of the difficulty of using routinely collected hospital data as an indication of performance.
"Depending on how the data is collected, reported waiting time data may not necessarily provide useful information to people seeking guidance on time to receive treatment," A/Professor Boyce said.
"They may be used to construct 'league tables' of the relative performance of surgical units - individual hospitals, surgical units or surgeons may be deemed to have 'good or even 'substandard' performance."
A/Professor Boyce stressed that most current indicators of health care performance should be viewed as tools that prompt further inquiry, rather than allowing definitive judgement on quality and safety of care.
The Medical Journal of Australia is a publication of the Australian Medical Association.
CONTACT: (Research) David Cromwell (02) 4221 4190 (B/H) Thur Aug 29
(02) 4228 0482 (A/H) Thur Aug 29 Contactable via Email from Fri Aug 30Email: cromwell@uow.edu.au
(Editorial) Neil Boyce (03) 9694 0142 (B/H) Contactable from Mon Sept 2
Sarah Crichton AMA (0419) 440 076