Perceptions of Otolaryngologists on Single-Entry Models for Managing Wait Times in Community-Based Health Care in Ontario: A Qualitative Study

Justin Shapiro¹, Jonah Perlmutter², Charlotte Axelrod³, Saruchi Bandargal⁴, Gabie Pundaky⁵, Ben B Levy⁶, Veronica Grad⁵, John de Almeida^{6

7}, Joel Davies^{6

8}, Brian Rotenberg^{1

9}, Antoine Eskander^{6

10

11}, Janet Chung^{6

11

12}, David R Urbach^{11

13

14}, Yvonne Chan^{6

15}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada.
² Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
³ Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada.
⁴ Faculty of Medicine, McGill University, Montreal, QC, Canada.
⁵ Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
⁶ Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
⁷ Department of Otolaryngology-Head and Neck Surgery, University Health Network, Toronto, ON, Canada.
⁸ Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, ON, Canada.
⁹ Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, London, ON, Canada.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, ON, Canada.
¹¹ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
¹² Division of Otolaryngology-Head and Neck Surgery, Trillium Health Partners, Mississauga, ON, Canada.
¹³ Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁴ Department of Surgery and Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
¹⁵ Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, Toronto, ON, Canada.

PMID: 40371874
PMCID: PMC12081981
DOI: 10.1177/19160216251336682

Perceptions of Otolaryngologists on Single-Entry Models for Managing Wait Times in Community-Based Health Care in Ontario: A Qualitative Study

Justin Shapiro et al. J Otolaryngol Head Neck Surg. 2025 Jan-Dec.

. 2025 Jan-Dec:54:19160216251336682.

doi: 10.1177/19160216251336682. Epub 2025 May 15.

Authors

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada.
² Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
³ Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada.
⁴ Faculty of Medicine, McGill University, Montreal, QC, Canada.
⁵ Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
⁶ Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
⁷ Department of Otolaryngology-Head and Neck Surgery, University Health Network, Toronto, ON, Canada.
⁸ Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, ON, Canada.
⁹ Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, London, ON, Canada.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, ON, Canada.
¹¹ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
¹² Division of Otolaryngology-Head and Neck Surgery, Trillium Health Partners, Mississauga, ON, Canada.
¹³ Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁴ Department of Surgery and Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
¹⁵ Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, Toronto, ON, Canada.

PMID: 40371874
PMCID: PMC12081981
DOI: 10.1177/19160216251336682

Abstract

ImportanceLong wait times for medical care have been exacerbated following the pandemic in many health systems. Single-entry models (SEMs) have been proposed as a strategy to manage growing surgical backlogs and increase timeliness and quality of care by creating a single queue and centralizing the referral triage process.ObjectiveThe primary objective was to evaluate the perceptions of SEMs among community otolaryngologists for managing surgical backlogs. The secondary objectives were to better understand their experiences with the current system and to investigate their recommendations for implementing an SEM.DesignInterpretive Description.SettingOntario, Canada.ParticipantsNine community-based otolaryngologists.Intervention/ExposuresNot available.MethodsVirtual semi-structured interviews were conducted with study participants. Data were independently analyzed using inductive and deductive methods by multiple team members. Results were triangulated, and a final coding framework was developed collaboratively from which themes were identified.Main Outcome MeasuresPerceptions of SEMs as well as recommendations for design and implementation.ResultsThree thematic domains and 9 subdomains were identified from our interview data: (1) factors affecting the utility of SEMs; (2) opinions and buy-in of physicians; and (3) opportunities to improve equity.Conclusions and RelevanceWe identified a number of factors that should be considered in supporting community-based otolaryngologists to adopt SEMs as a strategy for ensuring timely and equitable access to care. Clinical leaders and specialty organizations play a pivotal role for such changes to succeed. Implementing SEMs may be an important step toward increasing equity, quality, efficiency, and cost-effectiveness in otolaryngology.

Keywords: allergy/rhinology; clinical; clinical research; health policy; health services; outcomes/cost-effectiveness; pediatrics; quality of life.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

**Figure 1.**
Key themes and frequencies across interviews.

**Figure 2.**
Example of patient flow through a SEM. SEM, single-entry model.

See this image and copyright information in PMC

References

1. Blumenthal D, Fowler EJ, Abrams M, Collins SR. Covid-19—implications for the health care system. N Engl J Med. 2020;383(15):1483-1488. doi:10.1056/NEJMsb2021088 - DOI - PubMed
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1. Urbach DR. Improving access to health services in Canada. Healthc Manage Forum. 2018;31(6):256-260. doi:10.1177/0840470418776995 - DOI - PubMed

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Perceptions of Otolaryngologists on Single-Entry Models for Managing Wait Times in Community-Based Health Care in Ontario: A Qualitative Study

Affiliations

Perceptions of Otolaryngologists on Single-Entry Models for Managing Wait Times in Community-Based Health Care in Ontario: A Qualitative Study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources