The IGAS audit on access to the first hospital specialty consultation at Amadora-Sintra Local Health Unit (ULSASI) aimed to evaluate the functioning of the Integrated Access Management System in the SNS (SIGA SNS), specifically the SIGA for first hospital specialty consultations (SIGA 1st Hospital Consultation).
The IGAS concluded that between 2022 and 2024, “the Amadora-Sintra ULS failed to consistently guarantee access to the first hospital specialty consultation according to the principles of equity, equality, and in a timely manner.”
The audit revealed that the SIGA 1st hospital consultation is not implemented at the ULS as designed, “not allowing the management of access to the SNS in an integrated manner, nor providing a transparent view of the user’s journey within the entity.”
IGAS emphasizes the need to integrate all existing information regarding the management of first specialty consultation requests into a standardized and homogeneous IT system, simplifying scheduling and allocation of slots.
Several irregular situations were identified by IGAS, such as the registration of consultations conducted before entry into the Waiting List for Consultation (LEC) was recorded, scheduling consultations according to dates set by the triage physician without administrative control of the antiquity criteria in the LEC.
Consultations recorded in the information system as follow-ups but counted and billed as first consultations, entries into LEC in 2023 unaccounted in the same specialty the previous year, and requests missing or incorrectly identifying the origin or user on the Waiting List for Consultation were other detected flaws.
Additionally, most specialties lack clear and transparent information on episodes generated based on internal or intra-hospital referrals or requests supported on paper without triage registration and priority levels assignment.
Between 2022 and 2024, the institution showed “an unfavorable evolution of the ability to resolve waiting lists for the first specialty consultation.”
Particular attention is needed for requests that have been on LEC for more than nine months, especially those originating from primary healthcare.
At the end of 2022, there were approximately 2,720 referrals waiting for a first specialty consultation for over nine months in LEC, a number that increased to 5,780 in 2023, and 7,618 in 2024.
IGAS issued 25 recommendations to the Amadora-Sintra ULS “aimed at improving criteria and control of integrated management of waiting lists for the first hospital consultation,” which were generally accepted by the institution.
Recommendations include ensuring clear information dissemination on the offer of consultations, specialty, and subspecialties, guaranteeing monitoring and assessment of compliance with guaranteed maximum response times, and preventing requests on LEC without registered priority after triage.
It also recommends empowering referring physicians and triage officers for correct use of SIGA First Hospital Consultation to avoid “avoidable situations of returning requests for first consultation bookings due to lack of basis or absence of attached clinical results, thus preventing delays in response time to requests.”
