I was thinking about the person whose lists just kept getting longer, but I couldn't find the thread.
What I haven't done, which might help (I'm going to do it today), is to go to the higher level. What are the areas of responsibility? Maybe there are too many and you have to get rid of some. What are the goals? If you haven't identified the goals, maybe it's time to do that and unload some things to do that aren't consistent with the goals you really want to achieve.
Now I'm going to log off and do just that, because I too have too much to do, and things aren't dropping of my projects list as fast as I would like.