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Dr. Jonathan Irish

Wait Time Reporting: The Wait is Over

Reflecting back to 2003, clinicians, patients and other stakeholders identified access to care as a major issue for some health services. Particular concern was expressed about wait times for surgical care for cataract surgery, joint replacement surgery, cancer surgery and cardiac surgery as well as for diagnostic imaging services including CT and MRI scans.

Over the last 14 years, the development of wait time targets and then documenting and reducing wait times so patients receive care when they need it has been a particularly noteworthy achievement which is now showcased on the Health Quality Ontario website with links from Ontario.ca/health too.

One of the major issues in 2003 was access to operating room resources. The time from the decision to operate until the date of the surgical treatment was felt to best reflect the availability of, and access to, these resources.

The Wait Time Information System was created in Ontario in 2005 as the first-ever information system in the province to collect accurate and timely wait time data, and since that time Ontario has publicly reported access to care performance against wait time targets for surgical and diagnostic imaging services.

Since then, the Wait Time Information System has expanded to all surgical services and now includes Emergency Room wait times, Alternate Level of Care bed utilization and efficiency as well as operating room efficiency targets.

Access to operating room resources from the time of the decision to operate until the date of surgery is only one part of the patient’s path through the health care system and we have recognized the importance of expanding the description of access to care for treatment.

One of the important parts of this pathway is the access for a patient to specialist consultation and care. For this reason, our Surgery and Diagnostic Imaging Council has been working on including public reporting of the date of referral to a specialist from a primary care provider to the date of first consultation with a specialist.

The launching of the new wait times data on the Health Quality Ontario website will allow patients, physicians, hospital administrators and others to access this data as well as other access to care performance measures.

Health Quality Ontario led the wait time website effort and, in collaboration with Cancer Care Ontario, the Cardiac Care Network (now CorHealth Ontario) and the Ministry of Health and Long Term Care, for the first time wait times for referral from a family physician to specialist will be reported.

The Health Quality Ontario website will provide a new user experience for all of the data (existing and new), and a new design that will make Health Quality Ontario’s online reporting accessible, meaningful and public-friendly, while also providing in-depth performance data for system stakeholders.

Reporting on wait times does not answer the question of whether such wait times are excessive and cannot on its own reduce wait times. But it does provide the necessary, accurate and accessible information to all stakeholders, public, providers and policy-makers alike to target improvement efforts.

The current situation represents substantial progress from 2003 when media reported on excessively long times for care. At that time, the only response from a physician or hospital administrator was “I’m doing my best.”

There was no province-wide wait time collection and there were no accepted well-defined performance targets for wait times in our health care system.

Thanks to leadership in Ontario, we created a wait time information system that now links over 100 hospitals and more than 3,500 surgeons, and allows near real time reporting on a monthly basis about how our system is reacting to the needs and demands of Ontario patients. The system also allowed us to establish guidelines, standards and targets to better triage the delivery of care.

By publicly reporting these data, everyone can see where there are hot spots that need addressing. But we can also now see where challenging situations have been solved and review what practices were implemented and use these best practices to apply to other areas of the system to achieve performance improvements. Increased transparency of wait times information has contributed to improvements in access for many patients.

Now, with the addition of wait times from primary care referral to specialty care, we are able to increasingly describe through the eyes of the patient more about the continuum of care from primary care consult to the operating room.

We have gone from having no useful information about wait times to having a good system. Getting to great will be another big step as we continue to improve the quality of care for our patients and report how our system is performing. Making our system more efficient, ensuring that the care is appropriate, that our system is equitable and integrated and that it provides patient-centred care will ensure that our system is dedicated to improving the experience of each patient that requires care in our health care system.

Dr. Jonathan Irish is Provincial Clinical Lead for Access to Services and Wait Times, and provincial head of the Surgical Oncology Program at Cancer Care Ontario.

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