Time on wait lists for coronary bypass surgery in British Columbia, Canada, 1991 – 2000

Levy, Adrian R.; Sobolev, Boris; Hayden, Robert; Kiely, Michael L.; FitzGerald, J Mark; Schechter, Martin T.

doi:10.1186/1472-6963-5-22

Cited by 31 publications

(29 citation statements)

References 21 publications

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“…This is particularly true for cardiac conditions, which are often amenable to evaluations based on index events such as cardiac catheterization and listing for surgery, which is captured by institutional, provincial and national datasets (1,7,8). We argue that, unfortunately, such wait time data underestimate the total wait time experienced by patients, which includes intervals in which the patient is waiting for different things and different people.…”

Section: Discussionmentioning

confidence: 96%

How established wait time benchmarks significantly underestimate total wait times for cardiac surgery

Légaré

Buth

2010

Canadian Journal of Cardiology

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W ait times for health care has been a popular topic in recent discussions of health care management and reform. However, the media tends to focus on wait times for surgery and high-technology imaging tests. These late-stage wait times are only a portion of the total wait time leading up to surgery. Thus, current metrics underestimate the total wait time surgical patients experience. For example, Munt et al (1) have found that current methods underestimate the wait time for surgical treatment of aortic stenosis by a factor of 3.2. Knudtson et al (2) have proposed that it is likely that patients face the greatest wait-related risk in the earlier phases of care, before the disease is adequately characterized.Recently, a number of authors have suggested alternate ways of defining wait times to reflect the patient's perspective on waiting for care. For example, Munt et al (1) have proposed that the wait time for cardiovascular surgery be redefined as "the time interval between the patient's first contact with a medical care provider with symptoms or signs which ultimately lead to cardiovascular surgery and the date of that surgery". This would effectually lead to an examination of the total wait time surgical patients experience. These authors propose that a universal wait time definition must meet three criteria: the time interval should be representative of the time the patient is at risk for morbidity and mortality; the time interval should be applicable and reproducible across all jurisdictions; and the time interval should be easily and inexpensively tracked, preferably with pre-existing databases (1,2).The present study represents pilot work designed to examine the feasibility of using administrative databases, specifically Nova Scotia's Medical Services Insurance (MSI) physician billing database, to METHODS:The Maritime Heart Center (Halifax, Nova Scotia) cardiac surgery database was used to identify all consecutive patients who underwent elective coronary artery bypass graft surgery between 2002 and 2005 from a single urgency queue. The provincial physician billing database provided a timeline record of dates, physician visits, and diagnoses or procedures performed for each patient. This information was used to assess total and component wait times leading to cardiac surgery. RESULTS: A total of 705 consecutive patients were included and stratified based on geographical location: urban Halifax Regional Municipality (HRM; n=222), urban non-HRM (n=220) and rural (n=263). Patients from all regions did not differ in age, sex, comorbidities or ventricular function. Using a traditional definition of wait time (time listed), patients waited a median of 56 days (interquartile range [IQR] 38 to 77 days). In comparison, the total wait times based on the time from presentation to surgery were a median of 109 days (IQR 56 to 184 days) for HRM, a median of 121 days (IQR 77 to 184 days) for urban non-HRM and a median of 123 days (IQR 79 to 169 days) for rural patients (P-value nonsignificant). Two modes of presentatio...

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Section: Discussionmentioning

confidence: 96%

How established wait time benchmarks significantly underestimate total wait times for cardiac surgery

Légaré

Buth

2010

Canadian Journal of Cardiology

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“…This population-based patient registry contains demographic, clinical and treatment data, along with the dates of booking request for operating room time and procedures for all adult patients undergoing CABG in any of the four cardiac centers in the province [8]. To identify cardiac catheterization dates, hospital admission and discharge dates, and coexisting medical conditions, we used each patient’s provincial health number to deterministically link BCCR records to the Canadian Institute for Health Information (CIHI) Discharge Abstract Database (DAD) [11].…”

Section: Methodsmentioning

confidence: 99%

“…In a previous study of access to non-emergency CABG in British Columbia, Canada, between 1991 and 2000, we found that waiting times for the procedure shortened after 1998 when annual supplementary funding was granted to tertiary care hospitals that had been providing cardiac surgical care to adult residents of the province [8]. Between 1995–1996 and 1999–2000, there was a 12% increase in the total number of CABG operations and a decline in median waiting time from 15 to 10 weeks, although the change in waiting times was different across urgency groups.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of supply-side initiatives to improve access to coronary bypass surgery

Sobolev

Fradet

Kuramoto

et al. 2012

BMC Health Serv Res

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BackgroundGuided by the evidence that delaying coronary revascularization may lead to symptom worsening and poorer clinical outcomes, expansion in cardiac surgery capacity has been recommended in Canada. Provincial governments started providing one-time and recurring increases in budgets for additional open heart surgeries to reduce waiting times. We sought to determine whether the year of decision to proceed with non-emergency coronary bypass surgery had an effect on time to surgery.MethodsUsing records from a population-based registry, we studied times between decision to operate and the procedure itself. We estimated changes in the length of time that patients had to wait for non-emergency operation over 14 calendar periods that included several years when supplementary funding was available. We studied waiting times separately for patients who access surgery through a wait list and through direct admission.ResultsDuring two periods when supplementary funding was available, 1998–1999 and 2004–2005, the weekly rate of undergoing surgery from a wait list was, respectively, 50% and 90% higher than in 1996–1997, the period with the longest waiting times. We also observed a reduction in the difference between 90th and 50th percentiles of the waiting-time distributions. Forty percent of patients in the 1998, 1999, 2004 and 2005 cohorts (years when supplementary funding was provided) underwent surgery within 16 to 20 weeks following the median waiting time, while it took between 27 and 37 weeks for the cohorts registered in the years when supplementary funding was not available. Times between decision and surgery were shorter for direct admissions than for wait-listed patients. Among patients who were directly admitted to hospital, time between decision and surgery was longest in 1992–1993 and then has been steadily decreasing through the late nineties. The rate of surgery among these patients was the highest in 1998–1999, and has not changed afterwards, even for years when supplementary funding was provided.ConclusionsWaiting times for non-emergency coronary bypass surgery shortened after supplementary funding was granted to increase volume of cardiac surgical care in a health system with publicly-funded universal coverage for the procedure. The effect of the supplementary funding was not uniform for patients that access the services through wait lists and through direct admission.

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“…Data were taken from a population-based registry set up to capture the time of registration for surgery, the time of surgery or removal from wait lists without surgery, for all patients accepted for coronary bypass surgery in the four tertiary hospitals delivering adult cardiac care to residents of BC [15]. Offices of all cardiac surgeons weekly provide information to the registry on registrations for surgery, operations performed, waitlist reconciliation (removals), and discharge summaries.…”

Section: Methodsmentioning

confidence: 99%

“…All cardiac surgeons in BC use a common guideline for prioritizing patients and assigning a target time for surgery based on angina symptoms, affected coronary anatomy, and left ventricular function impairment as described elsewhere [15]. Each patient was classified as urgent if the suggested time to surgery was three days, semi-urgent if the time was six weeks, and non-urgent if the time was 12 weeks.…”

Section: Methodsmentioning

confidence: 99%

Chances of late surgery in relation to length of wait lists

Sobolev

Levy

Kuramoto

et al. 2005

BMC Health Serv Res

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BackgroundThe proportion of patients who undergo surgery within a clinically safe time is an important performance indicator in health systems that use wait lists to manage access to care. However, little is known about chances of on-time surgery according to variations in existing demand. We sought to determine what proportion of patients have had late coronary bypass surgery after registration on wait lists of different size in a network of hospitals with uniform standards for timing of surgery.MethodsUsing records from a population-based registry, we studied wait-list times prospectively collected in a cohort of patients registered on wait lists for coronary artery bypass grafting procedures. We compared the number of weeks from registration to surgery against target access times established for three urgency groups. The chances of undergoing surgery within target time have been evaluated in relation to wait-list size at registration and the number of surgeries performed without registration on a wait list.ResultsIn 1991–2001, two in three patients were at risk of late surgery when registered on wait lists for isolated coronary bypass procedures in British Columbia, Canada. Although urgent patients had never seen a wait list with clearance time exceeding one week, the odds of on-time surgery were reduced by 25%, odds ratio [OR] = 0.75 (95% confidence interval [CI] 0.65–0.87) for every additional operation performed without registration on a list. When the wait list at registration required a clearance time of over one month, semi-urgent patients had 51% lower odds of on-time surgery as compared to lists with clearance time less than one week, OR = 0.49 (95%CI 0.41–0.60), after adjustment for age, sex, comorbidity, calendar period, hospital and week on the list. In the non-urgent group, the odds were 69% lower, OR = 0.31 (95%CI 0.20–0.47). Every time an operation in the same hospital was performed without registration on a wait list, the odds of on-time surgery for listed patients were reduced by 7%, OR = 0.93 (95%CI 0.91–0.95) in the semi-urgent group, and by 10%, OR = 0.90 (95%CI 0.87–0.94), in the non-urgent group.ConclusionChances of late surgery increase with the wait-list size for semi-urgent and non-urgent patients needing coronary bypass surgery. The weekly number of patients who move immediately from angiography to the operation without registration on a wait list reduced chances of surgery within target time in all urgency groups of listed patients. When advising patients who will be placed on the wait list about the expected time to treatment, hospital managers should take into account the current list size as well as the weekly number of patients who require CABG immediately after undergoing coronary angiography.

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Time on wait lists for coronary bypass surgery in British Columbia, Canada, 1991 – 2000

Cited by 31 publications

References 21 publications

How established wait time benchmarks significantly underestimate total wait times for cardiac surgery

How established wait time benchmarks significantly underestimate total wait times for cardiac surgery

Evaluation of supply-side initiatives to improve access to coronary bypass surgery

Chances of late surgery in relation to length of wait lists

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