Evaluation of booking systems for elective surgery using simulation experiments.

OBJECTIVE This study compared two methods of booking elective surgery - booking from wait lists and pre-booking surgery dates at the time of decision to operate - in terms of cancellations of elective procedures and time to surgery. METHODS The authors conducted simulation experiments with group randomized design, in which the unit of allocation was the hospital and the units of analysis were both the hospital and the patient. RESULTS In the case of pre-booking, cancellation of high-priority elective procedures was only one-third as likely as it was in the case of booking from wait lists (odds ratio 0.35; 95% confidence interval 0.18-0.68). After adjustment for hospital and patient factors, the weekly likelihood that patients on the wait list had their operation was about 20% higher for medium-priority procedures (OR 1.21; CI 1.18-1.24) after pre-booking surgery dates. CONCLUSION The findings suggest that redesigning booking processes may improve the performance of surgical services.