Open access as an intervention to improve outpatient waiting list

BACKGROUND: Waiting list management is a critical aspect of health care facilities, representing the excess of demand that could be guaranteed in a specific time. The effective implementation of policies to govern waiting lists requires the adoption of adequate organizational booking structures to contain the risk of underuse of care services and maximize their ability to ensure compliance with the maximum waiting time for each priority class. METHODS: The study analyzes the Open Access model adopted by the Azienda Ospedaliero-Universitaria Pisana (AOUP). The model involves booking within 3 days and daily sliding of services monitored by a Regional masterplan, with supply evenly distributed throughout the week. Since Open Access model was implemented in June 2020, the study analyzes the effect of this between June 1, 2019 and May 31, 2021, regarding specialist visits and diagnostic tests. RESULTS: In the study time, the percentage of all guaranteed services within the national timeframe raised significantly from 84.02% to 93.56%. For example, rheumatology visit that went from 68% to 99%. Speaking of waiting time, allergology visit went from 96 days to 8 days and the pneumology visit from 82 days to 4 days. Visits that were already starting from times in line with priority also benefited from the methodology, such as the vascular surgery visit that went from 2 to 0 days. CONCLUSIONS: Therefore, proper governance of waiting lists is crucial in the healthcare system since timely access to healthcare services is an essential right for citizens and has a significant impact on the management of healthcare services. However, there are no one-size-fits-all solutions for managing waiting lists, but complex actions need to be implemented. The importance of digital tools for waiting list management is emphasized and adequate control structures are needed to detect any ‘anomalies’ and verify the proper functioning of the system of access to care. KEY MESSAGES: • Efficient waitlist management safeguards citizens’ rights to access to care and proper governance. • Control structures are crucial for effective management as a universal solution is unattainable.