A priority enabling system for waiting list management

The present invention relates to a priority enabling system and, in particular, to a system for use in healthcare institutions such as hospitals for managing waiting lists.

BACKGROUND OF THE INVENTION

In health care institutions such as hospitals, patients awaiting surgery or other procedural intervention are often placed on a waiting list. The waiting list is typically arranged according to specified degrees of urgency. Almost universally, these comprise Urgent, Semi-urgent and Elective categories. Within each category patients are usually listed in order of time waiting.

This arrangement has several disadvantages, including but not limited to the following:

• The basis upon which patients have been assigned a particular category is often not transparently defined.

• Patients are not homogenous in regard to their stage of illness or disease. As a consequence, patients within each broad category may have medical conditions with varying degrees of clinical urgency.

• In addition to the primary condition requiring treatment, there may be other factors that impact upon the degree of urgency with which treatment is required. These may include co-morbid medical conditions, social conditions, or other factors.

• The assignment of patients to categories means that an individual judgment is required to determine the relative priority of patients in different categories. Specifically, clinicians must determine how the waiting period of patients may impact on their assigned priority.

This is particularly of relevance to patients who have been assigned a lower initial degree of urgency, but may have been waiting much longer compared to patients in more urgent categories.

• The management of waiting lists is often devolved to relatively junior medical staff. As a result, the appropriate determination of relative urgency for patients within and between categories requires ongoing education and training.

Programs have previously been developed that assign waiting list priority based on a point scoring system. Such systems however are not broadly applicable to any procedural waiting list and, in particular, to those comprising a heterogeneous mix of patient conditions and intended procedures.

It is therefore an object of the present invention to overcome at least some of the above- mentioned problems or to provide the public with a useful and practical alternative.

SUMMARY OF THE INVENTION

Therefore in one form of the invention there is proposed a priority enabling system for waiting list management, said system characterised by: a means of identifying and assigning each person in the waiting list a primary curve relating to a primary factor, said primary curve defining a rate at which points are accrued over time; a means of modifying said primary curve in accordance with one or more secondary factors to produce a final curve which defines the total points accrued by each person in the waiting list at any one time.

Preferably said primary curve is predefined for each primary factor.

In preference said priority enabling system further includes a means of identifying one or more grades and assigning each person in the waiting list to a single grade.

Preferably said priority enabling system further includes a means of assigning each secondary factor to one of said grades.

In preference each secondary factor is in the form of a secondary curve which also defines a rate at which points are accrued over time.

In preference said secondary curve is predefined.

In preference said final curve is produced by the summation of the primary curve in a single grade, and the secondary curves across all grades.

Preferably said priority enabling system further includes a means of ranking each person in the waiting list according to the amount of points accrued at any one time in accordance with the final curve.

Alternatively a continuum of primary curves is defined within a range established by boundary curves defining the minimum and maximum rates at which points can be accrued over time.

Preferably said priority enabling system further includes a means of identifying said primary curve from the continuum of primary curves according to a nominated time which should be provided for a particular primary factor, and the points accruable at said maximum rate.

In preference each secondary factor is in the form of a percentage of the points accruable at said maximum rate.

In preference the percentage of points for each secondary factor is predefined.

In preference said final curve is produced by the multiplication of the primary curve established in a single grade, by the combined percentages of each secondary factor across all grades.

Preferably said system further includes a means of ranking each person in the waiting list according to the amount of points accrued at any one time in accordance with the final curve.

In a further form of the invention there is proposed a priority enabling system for hospital patient waiting list management, said priority enabling system characterised by: a means of identifying and assigning each patient in the waiting list a primary curve relating to an intended procedure to be performed on each patient or to a condition of said patient, said primary curve defining a rate at which points are accrued over time which is specific to said procedure or condition; a means of modifying the rate at which points are accrued over time in accordance with one or more modifying factors, such as a stage of disease or a co-morbid condition of a patient, to produce a final curve which defines the total points accrued by each patient in the waiting list at any one time.

Preferably said system further includes a means of identifying one or more general classifications of urgency, such as urgent, semi-urgent and elective, and assigning each person in the waiting list to a single classification.

In preference said system further includes a means of assigning each modifying factor to one of said general classifications or urgency.

Preferably each modifying factor is in the form of a secondary curve which also defines a rate at which points are accrued over time.

In preference said final curve is produced by the summation of the primary curve established in a single classification of urgency, and the secondary curves associated with said patient across all classifications of urgency.

In preference said system further includes a means of ranking each patient in the waiting list according to the amount of points accrued at any one time in accordance with the final curve.

In preference the higher the amount of points accrued, the higher the waiting list rank.

Alternatively a continuum of primary curves is defined within a range established by boundary curves defining the minimum and maximum rates at which points can be accrued over time.

In preference said system includes a means of identifying said primary curve from the continuum of primary curves according to the nominated time within which treatment should be provided for a particular condition or procedure, and the points accruable at said maximum rate.

Preferably each modifying factor is in the form of a percentage of the points accruable at said maximum rate.

In preference said final curve is produced by the multiplication of the primary curve established in a single classification of urgency, by the combined percentages of each modifying factor across all classifications of urgency.

Preferably said system further includes a means of ranking each person in the waiting list according to the amount of points accrued at any one time in accordance with the final curve.

Advantageously the higher the amount of points accrued, the higher the waiting list rank.

Preferably said condition or treatment, said modifying factors, and said general classification of urgency are specified when a patient is allocated to the waiting list.

In preference patients are allocated to the waiting list using a booking form. In preference said booking form is paper based or electronic.

In a still further form of the invention there is proposed a priority enabling system for hospital patient waiting list management, characterised by the steps of: identifying and assigning each patient in the waiting list a primary curve relating to an intended procedure to be performed on each patient or to a condition of said patient, said primary curve defining a rate at which points are accrued over time which is specific to said procedure or condition; and modifying the rate at which points are accrued over time in accordance with one or more modifying factors, such as a stage of disease or a co-morbid condition of a patient, to produce a final curve which defines the total points accrued by each patient in the waiting list at any one time.a priority enabling system for waiting list management, including a means of assigning an overall priority to persons placed on the waiting list.

Therefore, the present invention provides for a single waiting list to be created that recognizes the unique condition of each patient, and their relative urgency when compared to all other patients. Preferably the most urgent patients awaiting treatment appear at the top of the waiting list. Preferably the assignment of priority is dynamic, and undergoes recalculation at predetermined time intervals.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate an implementation of the invention and, together with the description, serve to explain the advantages and principles of the invention. In the drawings:

Figure 1 illustrates a Points vs. Time graph for establishing a final curve in accordance with a first embodiment of the present invention;

Figure 2 illustrates a Points vs. Time graph for establishing a primary curve in accordance with a second embodiment of the present invention; and

Figure 3 illustrates a Points vs. Time graph for establishing a final curve in accordance with the second embodiment of the present invention.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

The following detailed description of the invention refers to the accompanying drawings. Although the description includes exemplary embodiments, other embodiments are possible, and changes may be made to the embodiments described without departing from the spirit and scope of the invention. Wherever possible, the same reference numbers will be used throughout the drawings and the following description to refer to the same and like parts.

The present invention relates to a priority enabling system for waiting list management, and although specifically directed towards healthcare institutions such as hospitals, is not intended to be limited to any one application. The present invention is intended to be broadly applicable to any procedural waiting list.

The present invention involves patients being assigned a rank in a waiting list based on a numeric points system. More particularly, each patient is assigned an initial number of points when they are first placed on the waiting list. Subsequently, with greater time on the waiting list, the number of points increase. The rate and pattern of points accrual is calculated using pre defined equations based on:

• the primary waiting list category (herein referred to as the primary curve); and

• other conditions that may impact on waiting list priority (herein referred to as modifying factors or secondary modifiers).

The final plot of points accrued against time reflects the interaction of these elements. These factors are specified at the time of booking a patient to the waiting list, preferably using a booking form. Such a form may be electronic or paper based.

The primary curve is the initial curve which defines the accrual of points against time. These may be defined in several ways, depending on the preference of the user. For example, primary curves may be specified for each intended procedure, wherein a specific operation to treat a specific condition may have a uniquely defined primary curve. Surgery to remove a kidney for cancer, for example, would have its own unique primary curve assigned to it.

Alternatively, primary curves may be established for each general classification of urgency, for example, urgent, semi-urgent and elective.

Each booking form specifies the significance of the condition to be treated. The basis upon which this is determined will vary with the condition. Examples may include disease stage

(eg. cancer extent or symptom severity), or a general allocation of urgency (eg. urgent to non urgent). A specific primary curve is assigned to each grading. The initial score that is assigned, and the rate at which points accrue over time can be uniquely specified for each primary curve. As only one grading of patients condition will be selected, only one primary curve will be applied to any patient.

In defining the urgency for treatment, a time is nominated within which treatment should be provided. This time is herein referred to as the category period.

Therefore, the primary curve specifies:

• the number of points initially assigned to patients placed on the waiting list; and

• the rate at which points are accrued over time.

The primary curve defines the pattern of point accrual in the absence of any modifying factors.

Primary curves are structured such that all patients accrue the same number of points (eg 1000 points) at the end of their Category period. The manner in which patients accrue points prior to and after the Category period can be individually defined.

Specific factors may be identified that influence the urgency of treatment. As mentioned earlier, these are referred to as modifying factors. The nature of modifying factors will vary, depending on the condition being treated, and intended treatment. All of the factors that are relevant to the determination of urgency are specified on the booking form. These may include, for example, the stage of a disease, impact on lifestyle, or level of social support. Each of these co-factors may also be assigned a grading, for example, mild or severe.

The impact of modifying factors on primary curves can be defined in a number of ways, the present invention illustrating two such ways. According to a first embodiment, a primary curve can be established by way of a summation of primary and secondary curves. According to a second embodiment, this is achieved by way of a percentage adjustment of primary curves. Both embodiments represent the same underlying principle.

For each condition and procedure, specific modifying factors are identified. In this first embodiment, the influence of each modifying factor is then defined by assigning a secondary

curve. As with primary curves, each secondary curve also specifies the number of points initially assigned, and the rate at which points are accrued over time.

Secondary curves can be uniquely defined for each modifying factor. Modifying factors can be assigned a grading according to severity or significance. The initial score that is assigned, and pattern of points accrual over time can be uniquely specified for each grade of each of these secondary conditions. Unlike primary curves, any number of pre defined secondary factors may be selected for a given patient.

The final curve that is assigned to a patient is created through the summation of points from the single primary curve and any secondary curves that are selected. This final curve will be specific to each individual patient.

The skilled addressee would appreciate that final curves are created by selecting elements from a matrix of primary conditions, modifying factors and grades. The table shown in Figure 1, and the corresponding Points vs. Time Graph 10, indicates that a grade 2 has been assigned to a primary condition for example, having a predefined primary curve 12, and that there are three modifying factors each having their own secondary curve 14, 16 and 18. The higher the grade, the higher the initial number of points allocated to each curve. The pattern of accrual of points over time will be determined by the shape of the final curve 20, which is a summation of the single primary curve 12 and the secondary curves 14, 16 and 18 across all of the grades.

It is to be understood that patients on the waiting list are ranked according to the number of points each has accrued. Accordingly, the gradient of final curves will vary among different patients, and the order of patient ranking will vary at different times. Patients assigned a higher priority will begin with more initial points, and will accrue points more rapidly, compared to those having a lower priority.

Patients are placed on waiting lists for specific procedures, applied to the treatment of specific conditions. Primary and secondary curves are based on each combination of procedure and condition, for example, separate primary and secondary curves would be defined for kidney removal for cancer, as compared to kidney removal for a benign condition. Unique booking criterion are specified for each combination of procedure and condition. As mentioned, the documentation that supports the booking of specific procedures and conditions is the booking form which may be electronic or paper based.

In the second embodiment of the invention, an initial primary curve is defined and is subsequently modified through mathematical manipulation based on the presence of modifying factors.

A continuum of initial primary curves is defined within a range established by boundary curves. These boundary curves establish upper and lower limits for the rate of points accrual over time. Selection of an initial primary curve is then based on the specified time within which treatment should be given.

The influence of secondary factors is defined by a percentage multiplication of the scores assigned to the initial primary curve at each time.

The Points vs. Time graph 22 in Figure 2 shows a lower limit curve 24 and an upper limit curve 26, representing respective lower and upper limits of points accrual as a function of time on the waiting list. Also shown is the initial primary curve 28 which is a curve selected from the continuum of curves bound by the upper and lower limits.

This curve 28 is determined by specifying the time within which treatment should be provided (the Category Period B). Respective time intervals A and C represent the shortest and longest category periods. In graph 22, the curve selected would be based on the specification that treatment should be provided within time interval B, and X represents the equivalent point value.

A specific percentage of the points accrued at the upper limit is defined for each grade of each modifying factor, as shown in the table and corresponding graph 30 in Figure 3. In this embodiment, modifying factors influence the primary curve 28 through a process of points multiplication, resulting in a final curve 32. In this example, the value defined for the final curve 30 at any time is calculated as:

Primary curve value at time T multiplied by [X + Y + Z] %

In practice, each booking form (paper based or electronic) is structured to incorporate the primary condition, related grades, and all modifying factors together with related grades. For each form, primary and secondary curves are assigned to each gradation of the primary factor and each gradation of every modifying factor. These curves, once assigned, are set for each booking form. Primary and secondary curves can be selected from a range of stored, predefined

templates. For example, the present invention is adapted to be operable through a computer program and such templates would be contained within the program. The program would also allows unique curves to be created by defining the initial score, and score to be allocated at set time intervals. Most usually, these comprise 25%, 50% and 75% and 100% of the category period.

Therefore, in booking a patient on to the waiting list, a clinician will perform the following steps:

1. The appropriate booking form is selected, based on the intended procedure, and condition to be treated.

2. The grade of the primary condition is selected.

3. Any modifying factors are also selected, and the grade of each modifying factor defined.

4. This information is directly entered into the waiting list management program if an electronic interface is used.

Clinicians do not individually define or modify primary or secondary curves. These curves have been predefined for every field of each booking form. Clinicians only need to identify a primary category, and specify the presence and severity of any cofactors. The program automatically sums points assigned by the curves that have been allocated to each of the selected criterion. This summation will determine the initial score the patient receives. This initial score determines the assignment of initial priority on the waiting list.

The summation of curves also defines the rate at which points subsequently accrue over time. The rate of points accrual will determine the subsequent relative ranking of the patient at any point in time.

The waiting list ranks all patients according to their accrued number of points. A standard presentation would list patients in order of total points accrued at the time the report is generated. The information provided includes, but is not limited to, the following:

• Patient name

• Medical record number

• Intended treatment, including procedure and condition

• Total points accrued

• Date of initial placement on waiting list

• Days waiting outside the Category period

In one embodiment, patients placed on the waiting list in urgent or expedited categories could be specifically identified by font colour or bold type font.

The program also has the capacity for generating specific reports. These provide information regarding waiting list parameters, and booking activity. Reports may include, but are not intended to be limited to the following:

Overall waiting list statistics:

• Total number awaiting treatment

• Number of patients awaiting care in each category of procedure

• Number of patients awaiting care in each category of urgency

• Percentage of patients awaiting care outside their category time

• Mean waiting time for each category and each procedure type

Utilization:

• Proportion of patients booked from the waiting list in each category of procedure

• Proportion of booked patients who were outside a specific range of priority ranking defined by the program. For example, the proportion of patients booked who were ranked outside the most urgent 10%.

Patient parameters:

• When data entry is from an electronic booking form, the program can provide reports based on information linked to the booking form. This may include patient demographics, additional co morbid conditions and insurance or billing details.

Specific clinician reports:

• For shared waiting lists, the preceding reports can be generated for specific providers.

In summary, the waiting list management system of the present invention involves determining the impact of waiting time, and automatically assigns a priority that accounts for both clinical urgency and waiting period. The basis upon which waiting list priority has been assigned is transparent. Clinicians using the system are assured that the assignment of priority is automatic, independent, appropriate and defensible.

Further advantages and improvements may very well be made to the present invention without deviating from its scope. Although the invention has been shown and described in what is conceived to be the most practical and preferred embodiment, it is recognized that departures may be made therefrom within the scope and spirit of the invention, which is not to be limited to the details disclosed herein but is to be accorded the full scope of the claims so as to embrace any and all equivalent systems and methods.

Further advantages and improvements may very well be made to the present invention without deviating from its scope. Although the invention has been shown and described in what is conceived to be the most practical and preferred embodiment, it is recognized that departures may be made therefrom within the scope and spirit of the invention, which is not to be limited to the details disclosed herein but is to be accorded the full scope of the claims so as to embrace any and all equivalent devices and apparatus.

In any claims that follow and in the summary of the invention, except where the context requires otherwise due to express language or necessary implication, the word "comprising" is used in the sense of "including", i.e. the features specified may be associated with further features in various embodiments of the invention.