Measuring the quality of performance in the management of waiting lists: using cataract surgery as an example.

BACKGROUND Quality of care committees monitor waiting lists to ensure that patient care is not compromised. Frequently, waiting lists are determined by individual physicians, and no explicit criteria determine who is first in the queue. The quality of ophthalmologists' decisions for managing waiting lists of cataract patients, a high-volume elective patient group, was examined in a study of patients undergoing cataract surgery in 1997 in the Regina Health District, Saskatchewan, Canada. METHOD Ninety-eight patients scheduled for surgery were interviewed pre- and postoperatively regarding cataract symptomatology, visual and emotional functioning, coping strategies, and concerns with waiting periods. Ophthalmologists provided preoperative and postoperative information on visual functioning. RESULTS Even though no formal criteria guided decision making about how long patients should wait, wait periods conformed to general standards set by consensus of ophthalmologists unless patients decided to delay surgery. Patients voiced little concern about the waiting period, and difficulties with visual and emotional functioning were minimal. Surgery outcomes were not negatively affected by waiting periods, which were in part a function of physician case load but were also related to patient preference and the tendency to seek out reassurance. Visual acuity, cataract symptomatology, and visual functioning were not predictive of waiting time, suggesting that this information is not consistently being used to prioritize patients. CONCLUSION Waiting lists can be well managed by using individual physician decision making, although explicit formal decision-making rules would be helpful. A variety of methodologies and analyses can be used to evaluate the management of waiting lists and to assist in identifying criteria for assigning priority to patients.