Single-Entry Models in Surgical Services

Key Messages

• In the health care system, common elements of SEMs include pooled referrals and waiting lists, centralized intake through a single-entry point, and triage for urgency and appropriateness.
• Four programs including the use of SEMs from the Canadian context were examined: the Winnipeg Central Intake System for hip and knee replacements, the British Columbia Surgical Strategy, the Nova Scotia Hip and Knee Action Plan, and the Saskatchewan Surgical Initiative.
• SEMs were generally implemented as 1 element of broader strategies to reduce surgical waits and enhance quality and safety of surgical services.Key success factors for implementation of SEMs included:
  • Concurrent investments in surgical capacity and health system resources.
  • The establishment of standardized clinical pathways to reduce care variation.
  • Strong leadership, including a focus on change management and use of clinician champions.
  • Standardized data collection and public reporting on key performance indicators.
  • Concurrent focus on quality improvement and patient-centred care.
• Challenges for implementation of SEMs included:
  • Effectively managing change and resistance to change.
  • Challenges in other areas of the health system that could impact wait times.
  • Maintaining strategic focus and predictable funding, especially in the face of external shocks.