Summary
This working paper presents 1995-96 and 1996-97 elective surgery waiting times data collected by State and Territory health authorities and provided to the Institute's National Elective Surgery Waiting Times Data Collection. The focus is waiting times, rather than waiting lists because, without knowledge of the rate of turnover of patients on a waiting list, its size is not a reliable indicator of access to the hospital system or of the amount of time that a patient would be likely to have to wait, or to have waited, prior to surgery. Two types of data are the basis of this paper:
- data on patients who were added to or removed from waiting lists during 1995-96 and 1996-97 (throughput data), and
- data on patients who were on waiting lists at a particular time (census data).
The patients waiting for elective surgery are classified according to their clinical urgency into three categories, as detailed in Chapter 2. 'Extended waits' have been defined as waits longer than 30 days for clinical urgency category 1, waits longer than 90 days for clinical urgency category 2 and waits longer than 12 months for clinical urgency category 3.
Four measures relating to waiting times are presented. They are the proportion of patients admitted from waiting lists after extended waits, median waiting time for patients admitted from waiting lists, the proportion of patients on waiting lists (on a census date) with extended waits, and waiting list clearance times (the theoretical lengths of time it would take to clear all patients from the waiting lists, given several assumptions).
Nationally agreed definitions are the basis of the paper, however the definitions used and the hospitals included varied among the States and Territories and with time. Comparisons between the jurisdictions and between reporting periods should therefore be made with reference to the notes on data interpretation and limitations.
Extended waits and waiting times for patients admitted from waiting lists
About 12% of clinical urgency category 1 patients were admitted after extended waits in 1995-96 and 14% in 1996-97. About 19% of clinical urgency category 2 patients were admitted after extended waits in 1995-96 and 17% in 1996-97 (Tables 3.1 and 3.2).
The largest proportions of clinical urgency category 1 admissions with extended waits in both 1995-96 and 1996-97 were for urology and plastic surgery (Tables 3.6 and 3.7).
For category 1 patients in 1996-97 the indicator procedures with the highest proportions of admissions with extended waits were total hip replacement (52%) and total knee replacement (54%) (Table 3.8).
The median waiting time for clinical urgency category 1 patients admitted (in New South Wales, South Australia and the Northern Territory combined) was eight days in 1995-96 and nine days in 1996-97. For clinical urgency category 2 and 3 patients combined, it was 36 days in 1995-96 and 38 days in 1996-97 (Tables 3.9 and 3.10).
In both years, the shortest median waiting times for clinical urgency category 1 patients were for neurosurgery, cardio-thoracic and vascular surgery (six or seven days), while the longest median waiting times were for urology (Tables 3.9 and 3.10).
Patients with extended waits on waiting lists on census dates
About 38% of clinical urgency category 1 patients on waiting lists on 30 June 1996 had extended waits and 33% on 30 June 1997. For clinical urgency category 2 patients, about 43% had extended waits on 30 June 1996 and 42% on 30 June 1997 (Tables 3.17 and 3.18).
The largest proportions of clinical urgency category 1 patients with extended were for ophthalmology and orthopaedic surgery waits on 30 June 1996, and for ear, nose and throat, and orthopaedic surgery on 30 June 1997 (Tables 3.19 and 3.20).
The indicator procedures with the highest proportions of extended waits for clinical urgency category 1 patients on 30 June 1997 were total hip replacement (64%) and total knee replacement (69%) (Table 3.21).
Waiting lists
Most patients admitted from waiting lists were in clinical urgency categories 2 or 3 (65% in 1995-96 and 68% in 1996-97). The largest proportions of patients on waiting lists on 30 June were also in these groups (93% in both 1995-96 and 1996-97) (Table 4.1).
There was marked variation among the States and Territories in the proportions of patients who were categorised as clinical urgency category 1 for each surgical specialty (Tables 4.3 and 4.4).
General surgery accounted for the largest proportion of admissions in both 1995-96 and 1996-97 (28% and 27% respectively) and orthopaedic surgery accounted for the greatest number of patients on waiting lists on 30 June (22% and 24%, respectively) (Table 4.5).
The most commonly awaited indicator procedure was cataract extraction. This procedure was reported for over 5% of admissions from waiting lists in 1996-97 and nearly 8% of patients on waiting lists on 30 June 1997 (Table 4.8).
For all States and Territories the number of admissions and other removals from waiting lists represented about 100% of the additions for 1995-96 and 1996-97, indicating that the size of the waiting lists remained relatively stable over this period (Figures 4.4 and 4.5).
Clearance times
The clearance time for clinical urgency category 1 patients was less than one month for all surgical specialties in 1995-96. For 1996-97 the longest clearance time was 1.1 months, for ear, nose and throat, and orthopaedic surgery (Tables B.1 and B.2). For the different surgical specialties, clinical urgency category 2 clearance times ranged from 1.8 to 7.6 months in 1995-96, and from 2.0 to 6.3 months in 1996-97.
Orthopaedic surgery recorded the longest clearance times for clinical urgency category 1 patients in 1996-97 (1.1 month) and for clinical urgency category 2 patients in both 1995-96 (7.6 months) and 1996-97 (6.3 months) (Tables B.1 and B.2).
Total knee replacement had the longest clearance time in both clinical urgency category 1 (2.6 months) and clinical urgency category 2 (8.8 months) in 1996-97 (Table B.3).
Patient numbers
There were about 138,000 patients reported on waiting lists throughout Australia on 30 June 1996 and about 149,000 on 30 June 1997 (Table C.1).
There were about 384,000 patients admitted from waiting lists during 1995-96 and about 441,000 in 1996-97 (Table C.1).