This article assessed patient and surgeon views on maximum acceptable waiting times for hip and knee replacement. Mean maximum acceptable waiting times were 18 weeks for patients and 17 weeks for surgeons. The length of maximum acceptable waiting times for surgeons generally increased as the level of urgency decreased but was not the case for patients. Significant predictors of longer patient maximum acceptable waiting times were gender, a longer waiting time, and a perception of fairness in regard to waiting times. This study provides information that can assist policy makers in the development of acceptable benchmarks for waiting times.

Background: This article assessed patient and surgeon views on maximum acceptable waiting times (MAWT) for hip and knee replacement. In an attempt to manage waiting lists for scheduled surgical services, a number of strategies have been proposed or implemented in Canada such as prioritization of patients and strategies to increase the capacity of hospitals and staff. To date, the method used to identify acceptable waiting times remains unclear. The urgency of a patient's condition has been recommended to be factored into a patient's wait list placement, to improve fairness of access as patients enter the queue at different levels of urgency. The patient and surgeons views on maximum acceptable waiting times have also been suggested to be taken into account when setting waiting times benchmarks. This study was designed to assess patient and surgeon perspectives on MAWT and to link MAWT to levels of urgency.

Methods: Patients who had undergone a hip and knee replacement within the preceding 3 to 12 months were surveyed for their views on maximum acceptable waiting times. At the decision date for surgery, surgeons' views on MAWT and the patient's urgency were assessed. Potential determinants of patient and surgeon MAWT were also examined.

Findings: Mean MAWT for patients and surgeons were 18 weeks and 17 weeks, respectively. The length of MAWT for surgeons generally increased as the level of urgency decreased. However, for patients, their MAWT was not related to urgency levels. Significant predictors of longer patient MAWT were gender, type of joint, a longer waiting time, and a perception of fairness in regard to waiting times. Type of joint, ability to walk without significant pain, and potential for progression of the disease were significant predictors of a MAWT for surgeons.

Conclusions: Knowing the patients' and surgeons' views on maximum acceptable waiting times is important in determining more acceptable waiting times. Furthermore, benchmarks based on levels of urgency should ensure a more transparent and fair process of access to care. Knowing the determinants of MAWT can improve the access to medical services. This study can assist policy-makers in the development of acceptable benchmarks for wait times.

Reference: Conner-Spady, B., Johnston, G., Sanmartin, C. Patient and Surgeon Views on Maximum Acceptable Waiting Times for Joint Replacement. Healthcare Policy. 3(2): 102-116.

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