Priority surgery wait times improve

At least 75 per cent of surgery patients in Ontario, British Columbia and Quebec are now consistently getting priority surgeries within benchmark timeframes, according to a new report.

At least 75 per cent of surgery patients in Ontario, British Columbia and Quebec are now consistently getting priority surgeries within benchmark timeframes, according to a new report.

From a national standpoint, the fact all provinces are now measuring waits with the same benchmarks and doing "fairly well' is a good story, said Jenny Lineker, program lead for emerging issues with the Canadian Institute Health Information (CIHI) in Toronto.

CIHI released its report, Wait Times Tables — Comparison by Province, 2010, on Wednesday, a report that looks at patient wait times for the five priority areas identified by first ministers in 2004:

  • Cancer treatment.
  • Cardiac care.
  • Sight restoration.
  • Joint replacement.
  • Diagnostic imaging.

All provinces started tackling the five priority areas with various subpriorities and starting points, Lineker noted.

But only the three most populous provinces — Ontario, B.C. and Quebec —are doing consistently well for knee replacement surgery, which continues to have the longest waits.

Total waits for patients missed

People are having knee replacements at younger ages, and the sheer volume of people in the queue might be a contributing factor, Lineker said.

The general trend is in the right direction, said Dr. Chris Simpson, head of the cardiology division at Queen's University School of Medicine in Kingston, Ont.

But there is still a bit of discrepancy in waits for knee replacements surgery, with 75 per cent of patients in Newfoundland and Labrador, P.E.I., Nova Scotia, New Brunswick, Manitoba, Saskatchewan and Alberta not receiving the surgery within the 26-week benchmark.

The downside of the current approach to wait times is the focus on access to tests or procedures, which are just one part of the wait patients face, said Simpson, who co-chaired a 2007 conference on wait times.

Patients are happy to get surgery faster but if they have to wait longer to see an orthopedic surgeon in the first place then they may not gain overall, and the impact on their quality of life is much greater than what is being measured, he said.

The Canadian Medical Association's approach is to focus on the whole wait patients face, from the time they first need to see a doctor, getting in to see a specialist, wait for tests and surgery, and then rehab, Simpson said.

Simpson applauded provinces and medical societies for the progress but stressed more work needs to be done.

"I think we can't be complacent," Simpson said. "I think it needs a culture of continuous improvement, and I think public pressure needs to be put on all the time to make sure that patients have access to all the things they need."

Patients are gracious about waiting but they want to know how long they will wait and that it is safe to wait, he added.

Cardiac waits

For the first time, the institute looked at bypass surgery waits by priority level ranging from urgent to elective, but this only applies to one per cent of cardiac patients in the country, Simpson said. Patients needing other procedures such as pacemakers, stents and angioplasty are left out.

Provinces are also using a six-month benchmark for bypass. But cardiac specialists use a six-week medically acceptable maximum wait time based on evidence published in medical literature and expert opinion, Simpson said.

The report focused on provincial comparisons, but a separate analysis by the institute on meeting benchmarks showed that across Canada benchmarks were met for:

  • 86 per cent for hip replacements.
  • 81 per cent for knee replacements.
  • 87 per cent for cataract surgery.
  • 86 per cent for cardiac by pass surgery.
  • 79 per cent for hip fracture (excluding Quebec which measures this wait differently)

Some provinces have also expanded measurements to other areas such as emergency department and primary care waits, Lineker said.

  Provinces completing 75% of procedures within benchmark timeframes     

 Hip replacement

Surgery within 26 weeks

 Knee replacement

Surgery within 26 weeks

Cataract surgery *

Surgery within 16 weeks

Hip fracture repair

Surgery within 48 hours

Cancer - radiation treatment 

Treatment within 4 weeks (28 days) of being ready to treat

N.L.  No  No  Yes  No data available   Yes (within 30 days)
P.E.I  Yes No Yes No data available  Yes
N.S.  No No  No Yes   No
N.B.   Yes No  Yes  Yes  Yes
Que.  Yes  Yes  No data available  No data available  Yes
Ont.  Yes  Yes Yes  Yes  Yes
Man.   No  No  Yes  Yes  Yes
Sask.  No  No  Yes  Yes  Yes
Alta.  Yes  No  No  Yes  No
B.C.  Yes  Yes  Yes  Yes  Yes

Source: Canadian Institute for Health Information    

* The pan-Canadian benchmarks specifies surgery within 16 weeks for patients who are at high risk. There is not yet consensus on a definition of "high risk," so this benchmark applies across all priority levels.