Did you know that each time a patient does not come for their scheduled appointment or procedure the wait list grows?
This is because the missed appointment time goes unused instead of being booked for another patient who is waiting, and an additional appointment slot has to be used to reschedule the patient who missed their appointment.
The following are some of the more common questions about wait lists and wait times:
What is a wait list?
A wait list is a roster of patients who are waiting for a particular service, physician, test, treatment or procedure.
What is a wait time?
A wait time is the length of time between the date a patient agrees to a procedure and is placed on the wait list, to the date when they receive the service they were waiting for.
What is a reasonable wait time?
Wait times depend on the type of procedure and the clinical condition of each individual. A patient’s priority is determined by his/her condition as assessed by the doctors involved in their care. In providing care and treatment based on clinical assessment, patients requiring immediate or urgent treatment receive care before patients in need of routine or non-urgent procedures. While some waiting is reasonable, and even at times necessary to plan treatment appropriately, prolonged wait times can be stressful and emotional for patients and their families.
How are wait times managed?
The responsibility for managing wait times is shared among the Department of Health and Community Services, the RHAs, physicians, health care providers, and individual patients.
The Department of Health and Community Services provides funding to the four RHAs. The Department establishes the legislative and regulatory framework for the provision of health and community services across Newfoundland and Labrador and sets provincial policy and guidelines for the health care system. The Department sets the direction for provincial wait time reporting requirements starting with the benchmark priority areas.
Physicians assess individual patient needs, including the urgency of the procedure, treatment or test they determine a patient needs. Physicians and RHAs work in close collaboration to prioritize patients and coordinate wait list management.
The RHAs are responsible for the administration and delivery of health services, as well as the operation of hospitals within the communities they serve.
This includes responsibility for the day-to-day management and coordination of the health care services they provide and monitoring and reporting wait times for benchmark priority procedures.
For example, RHAs coordinate operating room scheduling. Patients are selected from wait list and scheduled for surgery on the basis on urgency, best use of operating room time, and availability of hospital resources and staff. Keeping in mind that emergency cases have first access, which may result in cancellation of elective surgeries.
How are wait times measured?
For the majority of procedures, wait time starts with “decision to treat”. This is when the patient and the appropriate physician agree to a particular service, and the patient is ready to receive the service. Wait time ends when the patient receives the service, or an initial service in a series. The wait time is then measured in calendar days.
How are hip fracture repair wait times measured?
The national benchmark for hip fracture repair is 48 hours. As a result, the wait time for this operation is measured in hours instead of calendar days.
How are cataract surgery wait times measured?
As the majority of the wait time to undergo cataract surgery is for surgery on the first eye, cataract wait times are reported for the first eye cases.
Why are there variations in wait times?
Wait times will vary over time and will be influenced by a number of factors:
- Emergency cases: An increase in the number of emergency cases can increase the wait times for non-urgent cases because the sickest patients are cared for first. A high number of emergency cases can also mean that non-urgent cases are bumped or have to be cancelled and rescheduled for a later date.
- Patient choice: Patients may choose to wait longer for a particular provider or location, instead of opting for the first next available provider or location.
- Patient optimization: Patients may be placed on the wait list too early in the process before they are ready for surgery. For example, some patients may be advised to lose weight, while others may need to maintain a stable blood sugar level before surgery. In other situations, treatment may need to be delayed until a patient undergoes the necessary pre-op consultations, tests or optimization regime before they are ready to undergo surgery.
- Treatment complexity: Specific resources may be required for a patient with special requirements, resulting in a delay until these cases can be scheduled.
- Appropriateness of referrals: Processes to screen requests to ensure the appropriate procedure is ordered the first time can help to reduce long waits or unnecessary delays.
- How the wait list is managed: The policies and practices physicians and health regions use to manage patient wait lists and prioritize patients.
- The size of the wait list: The number of patients needing a procedure and the length of the wait list when a patient is added.
- Short notice cancellations: When patients cancel an appointment or procedure without giving sufficient notice, this procedure time is lost and cannot be regained.
- No shows or did not attend: When patients do not attend their scheduled appointment or procedures, this time slot goes unused instead of being offered to another waiting patient.
- Lost to follow-up: When patients forget to inform their health care provider of changes in their contact information (telephone number and mailing address) time is wasted trying to reach patients, which causes unnecessary wait time delays.
- Seasonal variations in demand: A patient may wish to defer elective surgery during the summer, while parents may prefer their child undergo elective surgery in the summer so they can recuperate before school resumes.
- Seasonal variations in capacity: The seasonal reduction in services during peak vacation periods may result in increased wait times.
- Availability of health providers and resources: The availability of health care professionals in the operating room and nursing unit can influence how quickly people receive surgery. Additionally, the unavailability of inpatient hospital beds for surgical patients can be a limiting factor, resulting in postponement or cancellation of elective operations.
- Efficient communication between health care providers: This is necessary to reduce or avoid repetition of tests and to ensure the most appropriate test is ordered the first time.
- Changing health needs of a community: Wait time for surgery may grow as more people have a need for a particular health service. For example, an area with a large senior citizen population is likely to experience a high demand for cataract surgery.
How are wait times calculated?
The wait times are calculated by subtracting the “decision to treat” start date from the “treatment received” end date, resulting in a wait time that is measured in calendar days. Patients with unavailable days or self-imposed delays are excluded from the wait time calculation, while system delays are included. The wait time calculations posted are based on completed cases carried out within a specific time. For example, the number of cases completed from April 1 to June 30 in a particular year.
Emergency cases: Patients who require emergency care are not placed on wait lists – they receive immediate access to care.
What wait time measures are reported?
50% completed within: This is the point at which half of the patients have had their surgery/treatment, and the other half are still waiting. For example, 50% of cases were completed within 90 days, this means that half, or 5 out of 10 patients received treatment in 90 days or less; the other half waited more than 90 days. This measure is also referred to as the median wait time.
90% completed within: This is the point at which 90%, or 9 out of 10 patients received their surgery/treatment, and the other 10% waited longer. For example, 90% of cardiac bypass patients underwent surgery within 142 days, and the remaining 10% waited beyond 142 days. This measure is also referred to as the 90th percentile.
Percent within benchmark: This is the proportion of cases completed within a specific clinically recommended timeframe. For example, 98% of cardiac bypass surgeries were completed within the 182 day benchmark target.
Who collects the wait time data?
The RHAs including the Provincial Breast Screening Program and the Provincial Cervical Screening Initiatives Program collect and report de-identified aggregate wait time data to the Department of Health and Community Services, on a regular basis. The information on this web site has been supplied and verified by the RHAs before being sent to the Department, and every effort is made to ensure data accuracy, including manual and/or electronic chart audits if necessary.