Surgical waiting lists and queue management in a Brazilian tertiary
public hospital
Abstract
Introduction: Centralized management of queues helps to reduce
the surgical waiting time in the publicly funded healthcare system, but
this is not a reality in the Brazilian Unified Healthcare System.
Objectives: To describe the implementation of the “Patients
with Surgical Indication” (PSI) in a Brazilian public tertiary
hospital; To assess the impact on waiting time and its use in rationing
oncological surgeries during the COVID-19 Pandemic. Methods:
Retrospective observational study of elective surgical requests
(2016-2022) in a Brazilian general, public, tertiary university
hospital. We recovered information regarding the inflows (indications),
outflows and their reasons, the number of patients, and waiting time in
queue. Results: We enrolled 82,844 indications in the PSI
(2016-2022). The waiting time (median and interquartile range) in days
decreased from 98(48;168) in 2016 to 14(3;152) in 2022
(p<0.01). The same occurred with the backlog that ranged from
6,884 in 2016 to 844 in 2022 (p<001). During the Pandemic,
there was a reduction in the number of non-oncological surgeries per
month (95% confidence interval) of -10.9(-18.0;-3.8) during Phase I
(January 2019-March 2020), maintenance in Phase II (April 2020-August
2021) 0.1(-10.0;10.4) and increment in Phase III (September
2021-December 2022) of 23.0(15.3;30.8). In the oncological conditions,
these numbers were 0.6(-2.1;3.3) for Phase I, an increase of
3.2(0.7;5.6) in Phase II and 3.9(1 ,4;6,4) in Phase III.
Conclusion: Implementing a centralized list of surgical
indications and developing queue management principles proved feasible,
with effective rationing. It unprecedentedly demonstrated the decrease
in the median waiting time in Brazil.