A novel multi-criteria decision-making approach for prioritization of elective surgeries through formulation of “weighted MeNTS scoring system”

Background: Publicly funded healthcare system has long non-manageable elective surgery waiting lists due to the non-existence of systematic mathematical modelling that can assess the relative priority of patients on elective surgery waiting lists thus denying the provision of surgical support to the patients with higher urgency. Mostly the patients of general surgery are entertain with highly subjective "time-honoured" methods that are inadequate to measure and compare the urgency of surgical procedure. Objective: A methodology of assigning priorities to patients on elective surgery waiting lists has been presented in this paper using weighted criteria objectives. The objectives hve been chosen and assigned weights based on hospital conditions, and in consultation with the surgeons in hospital in Pakistan. Methods: The proposed methodology presents two working contributions; first, a scoring mechanism based on MeNTS scoring system with weighted criterion that objectively translate the condition of patient prior to the surgical procedure; and second, a patient prioritization methodology to select patients for surgeries according to the corresponding scores. Detailed simulation results from actual patient data have been presented to evaluate the effectiveness of the proposed methodology, and its applicability and ease of use has been tested in real-time by surgeons while providing consultations to their patients. Results: The proposed methodology outperforms the traditional "first-come-first-serve" methodology as there was a 30% reduction in average waiting time in elective surgery waiting lists (from 4.246 to 2.956 days) with 103 (90%) of patients being entertained before or within the unprioritized surgeries time span, with 94 patients having surgery within 1 day of being on waiting list (an increase of 47 patients). Moreover, transparency and equity were also found in the adaptation of this strategy to prioritize the elective surgery patients. Conclusions: Prioritizing patients on elective surgery waiting lists is an important concern in surgical field. In most of the methodologies presented in earlier research, prioritization of patients for surgery is carried out subjectively. This study shows that the proposed technique has the potential to decrease the waiting times for patients on elective surgery waiting lists, as well as be presented as an objective methodology for preparing the elective surgery waiting lists to increase the transparency in waiting list.