Scoping Review Protocol Targets Elective Surgery Waitlists Across Public Health Systems
Elective surgery waiting lists remain a persistent pressure point for public health systems, where delays can worsen symptoms, prolong disability, and widen inequities in access. This scoping review protocol is designed to map the strategies used to manage waiting lists and prioritise access for surgery, with a focus on how public systems organise, implement, and adapt those approaches in real-world settings.
Rather than testing one intervention against another, the review is structured to catalogue the range of policies and operational tools already in use. That distinction matters in a field where access problems are rarely caused by a single failure. Referral pathways, triage rules, local workforce constraints, case-mix complexity, and political pressure all shape who gets surgery first and how long others wait.
Broad Search Design Aimed at Capturing Real-World Practice
The protocol sets out a comprehensive search across multiple electronic databases and grey literature sources, with no language or publication date restrictions. A design this wide is well suited to a topic where important operational details often live outside conventional journal articles, including health system reports, policy documents, and implementation guidance.
The review will use the Population–Concept–Context framework to define eligible material. In practical terms, the population is elective surgery patients, the concept is waitlist management and access prioritisation, and the context is public health systems. This framing keeps the review anchored to service delivery rather than narrowing it to one specialty or one country.
Two reviewers will independently handle study selection and data extraction. In a scoping review, that kind of duplicate screening is not just a methodological courtesy; it helps reduce selection drift when papers describe similar strategies in different terms or when policy documents blur the line between formal prioritisation and informal queue management.
Why Prioritisation in Elective Surgery Is Clinically and Operationally Complex
Waiting list management is more than an administrative exercise. For patients, delay can mean progressive pain, declining function, psychological stress, and repeated use of emergency or interim care. For clinicians, it can mean deciding how to translate urgency, benefit, equity, and resource scarcity into a sequence of operations that is defensible and transparent.
Many systems have moved beyond simple first-come, first-served arrangements because those models can unintentionally entrench inequality. Patients with better health literacy, stronger advocacy, or easier access to referrals often move faster through the system. Prioritisation strategies attempt to counter that effect by weighting clinical need, expected benefit, waiting time, or social vulnerability. The review is positioned to capture how those criteria are actually operationalised, not just how they are described in policy language.
Frameworks Chosen to Organize Heterogeneous Evidence
The protocol will follow established scoping review guidance, including the Arksey and O’Malley framework, Joanna Briggs Institute recommendations, and PRISMA-ScR reporting standards. That combination is important because the evidence base is expected to be heterogeneous. Some studies may evaluate triage systems, others may describe implementation barriers, and others may report service outcomes such as waiting times or throughput.
To strengthen interpretation, the review also plans to use the Consolidated Framework for Implementation Research. This choice signals that the authors are not only interested in what strategies exist, but also in the conditions under which they can be adopted, sustained, or abandoned. Implementation science is especially relevant here because a prioritisation tool that works in one jurisdiction may fail in another if staffing, information systems, governance, or clinical culture differ substantially.
What the Review Will Map, and What It Will Not Claim
The planned synthesis will focus on strategies, implementation features, contextual factors, and reported outcomes. In a scoping review, that kind of mapping is useful when the literature is too varied for a conventional effectiveness review. The protocol does not aim to estimate comparative effectiveness or establish causal effects, and that restraint is methodologically appropriate. A queue management policy may improve throughput in one hospital while producing bottlenecks elsewhere if staffing, case mix, or surgical capacity changes at the same time.
The review is also designed to identify how prioritisation is framed across different systems. Some jurisdictions may emphasize clinical urgency, while others may incorporate waiting time guarantees, equity metrics, or disease-specific targets. Others may rely on centralized scheduling tools, manual triage panels, or hybrid approaches that combine clinician judgment with scoring systems.
In that sense, the review has the potential to show how policy choices translate into bedside consequences. A prioritisation rule can determine whether a patient with worsening mobility, escalating pain, or functional decline is moved forward in time to avoid more invasive care later. A waitlist system that is transparent and consistently applied may also reduce conflict between patients, clinicians, and administrators when demand exceeds capacity.
Transferability Across Systems Will Depend on Context
Public health systems do not operate under identical constraints. Urban centers may have different staffing patterns and surgical volumes than rural networks. Some systems maintain centralized registries, while others rely on dispersed departmental lists. Funding structures, legal mandates, and data infrastructure also influence whether prioritisation policies can be measured and audited.
The protocol’s use of implementation-focused frameworks suggests an effort to capture those contextual differences rather than flatten them into a single model. This is clinically relevant because access prioritisation is rarely just about choosing the “best” rule. It is about whether a rule can be understood by front-line teams, accepted by patients, monitored by administrators, and adapted when resources tighten.
Anticipated Value for Policy and Service Design
If the review is completed as planned, it should provide a structured inventory of how elective surgery waiting lists are managed in public systems and which factors shape those approaches. Health services researchers, hospital leaders, and policy makers may use that map to compare models across jurisdictions and identify where prioritisation practices are documented but not well evaluated.
The protocol also creates a foundation for future work that moves beyond description. Once the field is mapped, more targeted studies can examine which strategies improve fairness, reduce delays, or preserve transparency under pressure. For now, the most important contribution is definitional clarity: what systems are doing, how they are doing it, and which contextual conditions appear to govern whether the strategy can function at all.
The review will not answer which prioritisation method is superior, because the evidence is not being assembled to make that claim. It will, however, define the range of approaches currently used to manage elective surgery access in public health systems, and it will do so with enough methodological breadth to expose where the evidence is thin, inconsistent, or absent.