Reducing waiting times for pediatric adenotonsillectomy through a value-based healthcare service redesign: an interrupted time series study.

BACKGROUND

Publicly funded pediatric otolaryngology services may be affected by fragmented care pathways, inefficient use of operating capacity, and long waiting times for surgery. We evaluated whether a value-based healthcare (VBHC) service redesign, organized around an integrated practice unit (IPU), could improve access to pediatric adenotonsillectomy in Warsaw.

METHODS

We conducted an implementation evaluation at Warsaw Hospital for Children. The IPU-based program was launched in October 2022 and included standardized care pathways, multidisciplinary assessment, centralized scheduling, parent communication, and monitoring of patient-reported experience and outcomes. The primary outcome was monthly median waiting time for elective pediatric otolaryngology surgery. Secondary outcomes included surgical throughput, lost operating room slots, bed use, length of stay, and readmissions. Interrupted time series analysis using segmented regression assessed changes in waiting time.

RESULTS

Between October 2022 and October 2024, 2500 children aged 0-18 years were treated within the program. Median waiting time decreased from 56 weeks in 2022 to 12 weeks in January-June 2023, 6 weeks in July-December 2023, and 4 weeks in 2024. Interrupted time series analysis showed a significant immediate reduction after implementation (β = -36.26 weeks; 95% CI -51.74 to -20.78; p < 0.001). Surgical throughput increased, with the median monthly number of procedures during October-December rising from 32 in 2022 to 51 in 2023 and 65 in 2024. Lost operating room slots decreased from 27 to 11. Readmissions were rare, with three events recorded among 2500 procedures.

CONCLUSIONS

A VBHC-informed IPU redesign was associated with shorter waiting times, improved operating room utilization, increased surgical throughput, and stable safety outcomes.