Wait Times for Cancer Surgery in British Columbia - BC Cancer ...
Wait Times for Cancer Surgery in British Columbia - BC Cancer ...
Wait Times for Cancer Surgery in British Columbia - BC Cancer ...
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<strong>Wait</strong> <strong>Times</strong> <strong>for</strong><strong>Cancer</strong> <strong>Surgery</strong> <strong>in</strong><strong>British</strong> <strong>Columbia</strong>Catal<strong>in</strong> Taraboanta MD.,MD., MSc.Manager, Cl<strong>in</strong>ical Practice Initiatives- February, 2009 -
<strong>Wait</strong> time:• Is the period of time the patient has to wait <strong>for</strong> an appo<strong>in</strong>tment ortreatment• <strong>Surgery</strong> wait time• Time elapsed between first physician appo<strong>in</strong>tment and date of surgery• Time between first referral to see the surgeon and date of surgery• Time between decision-to-treat has been made by the surgeon to date of surgery• Time from the moment OR book<strong>in</strong>g <strong>for</strong>m received to date of surgery
In Focus:• June 2006 – F<strong>in</strong>al Report of the Federal Advisor on <strong>Wait</strong> <strong>Times</strong> (MoH)• Encourage research, review of evidence and recommend benchmarks <strong>for</strong> patient care• Develop wait time tools (Canada Health Infoway)• Recommended the use of s<strong>in</strong>gle common wait<strong>in</strong>g lists• June 2008 – Draft Report on Status of <strong>Wait</strong> <strong>Times</strong> <strong>for</strong> <strong>Cancer</strong> Services <strong>in</strong>Canada (CAPCA)• True wait time <strong>in</strong>cludes only the time the patient waits <strong>for</strong> the system to provide care• Calendar days – consistent way to measure wait times• Means and 90 th percentile should be reported.(No data <strong>for</strong> cancer surgery <strong>in</strong> <strong>BC</strong>)• 2008 – Breast <strong>Cancer</strong> <strong>Wait</strong> <strong>Times</strong> <strong>in</strong> Canada – 2008 Report Card (C<strong>BC</strong>N)• Median wait time is 4 weeks (2004 – most recent available data)• 94% of women receive surgery by 9 weeks
Ontario:<strong>Cancer</strong> <strong>Surgery</strong>90thPercentile<strong>Wait</strong>Time(days)AccessTarget(days)% Completed With<strong>in</strong>Access TargetPriority 2 29 1462%Priority 3 44 2872%Priority 4 76 8493%Priority 2 – aggressive cancerPriority 3 – all cancer patients that are notemergent, priority 2 or 4Priority 4 – <strong>in</strong>dolent tumors<strong>Cancer</strong> surgery90 th percentile(days)Breast 37Bone, jo<strong>in</strong>t & muscle 52Eye 47Gastro<strong>in</strong>test<strong>in</strong>al 45Genitour<strong>in</strong>ary 69Head & neck 73Liver & pancreatic 48Gynecological 62Lung 40Neurological 55Prostate 94Thyroid & Endocr<strong>in</strong>e 126
<strong>BC</strong> Surgical Oncology NetworkThe Goal of Surgical Oncology Networkis to <strong>in</strong>tegrate quality surgical services<strong>in</strong> the <strong>for</strong>mal cancer care <strong>in</strong> <strong>BC</strong>
• SON started to work on <strong>Cancer</strong> <strong>Surgery</strong> <strong>Wait</strong> <strong>Times</strong> <strong>in</strong> <strong>BC</strong> to fill<strong>in</strong> the gap of <strong>in</strong><strong>for</strong>mation exist<strong>in</strong>g <strong>in</strong> the CAPCA report as well as aon <strong>BC</strong>CA Management Indicator report which lists radiotherapyand chemotherapy wait times.• SON established a <strong>Wait</strong> Time Work<strong>in</strong>g Group Committee underCl<strong>in</strong>ical Practice Committee:– Assessed the potential data sources to be used– Def<strong>in</strong>ed variables and periods to be reported– Focuses on target wait times (priority base system?)– Development of a cancer specific pre-operative assessment– Def<strong>in</strong>e and implement susta<strong>in</strong>able surgical wait time report<strong>in</strong>gmechanisms to accommodate short and medium term objectivesof the SON.
Def<strong>in</strong>itions:• Weeks s<strong>in</strong>ce Decision <strong>for</strong> <strong>Surgery</strong>: period of time elapsed between the daydecision <strong>for</strong> surgery has been made (as captured on Assessment Tool) ol) andthe day of surgery.• Weeks s<strong>in</strong>ce Book<strong>in</strong>g Received: period of time between when the ORbook<strong>in</strong>g <strong>for</strong>m is received and the date of surgery.• Cases per<strong>for</strong>med: where date of surgery is a day <strong>in</strong> the past• Cases wait<strong>in</strong>g: where date of surgery is today (the day is today <strong>for</strong> allunper<strong>for</strong>med surgeries)
Current SPR Reports12108<strong>Wait</strong> time <strong>in</strong> WeeksPer<strong>for</strong>med Casesby Health Authority6420Fraser (4,531) Interior (6,564) Northern (929) VancouverCostal (7,341)VancouverIsland (4,589)Decision to <strong>Surgery</strong> (Avg)Decision to <strong>Surgery</strong> (Median)Book<strong>in</strong>g received (Avg)Book<strong>in</strong>g received (Median)252015<strong>Wait</strong> time <strong>in</strong> WeeksCases <strong>Wait</strong><strong>in</strong>gby Health Authority1050Fraser (511) Interior (702) Northern (146) VancouverCostal (868)VancouverIsland (427)Decision to <strong>Surgery</strong> (Avg)Decision to <strong>Surgery</strong> (Median)Book<strong>in</strong>g received (Avg)Book<strong>in</strong>g received (Median)
Current SPR ReportsDecision Decision toto <strong>Surgery</strong> <strong>Surgery</strong>(Avg) (Median)Book<strong>in</strong>greceived(Avg)Book<strong>in</strong>greceived(Median)TotalCasesHA FacilityVancouver Lions Gate Hospital 4 3 2 3 496Costal Mount Sa<strong>in</strong>t Joseph Hospital 5 3 3 3 1,077Powell River General Hospital 3 3 2 3 58Squamish General Hospital 3 2 2 2 6St Mary's Hospital 8 4 5 4 20St Paul's Hospital 6 4 4 4 677The Rishmond Hospital 5 3 4 3 932Vancouver Acute - U<strong>BC</strong>H 6 5 4 5 993Vancouver Acute - VGH 6 4 4 4 3,082Summary 6 3 4 3 7,341Decision Decision toto <strong>Surgery</strong> <strong>Surgery</strong>(Avg) (Median)Book<strong>in</strong>greceived(Avg)Book<strong>in</strong>greceived(Median)TotalCasesHA SpecialtyVancouver General surgery 5 3 3 3 30,289Costal Gynecology <strong>Surgery</strong> 5 4 4 4 1,176Neurosurgery 9 4 7 4 449Ophtalmology <strong>Surgery</strong> 10 6 5 6 53Oral Maxillofacial <strong>Surgery</strong> - Dental Surgeon 4 4 4 4 1Oral Maxillofacial <strong>Surgery</strong> - Oral Surgeon 17 11 3 11 12Orthopedic <strong>Surgery</strong> 6 5 2 5 174Otoloarybgology <strong>Surgery</strong> 6 5 3 5 659Plastic <strong>Surgery</strong> 8 5 5 5 310Thoracic <strong>Surgery</strong> 4 3 2 3 769Urology <strong>Surgery</strong> 6 5 5 5 2,457Vascular <strong>Surgery</strong> 4 4 1 4 1Summary 6 5 4 5 9,350
Current SPR ReportNumber of Completed Cases and Average Weeks <strong>Wait</strong>ed From Book<strong>in</strong>g to <strong>Surgery</strong> <strong>for</strong>General <strong>Surgery</strong> between November 1, 2007 and October 31, 2008 by Health Authority,Encounter Type and <strong>Cancer</strong> Status<strong>Cancer</strong> Flag<strong>Cancer</strong> SuspectedNot Reported or Known No <strong>Cancer</strong>SpecialtyDescriptionGeneral<strong>Surgery</strong>EncounterType - HAregroupedDay <strong>Surgery</strong>InpatientHealthCount ofCasesAvg. Weeks:Book<strong>in</strong>g to<strong>Surgery</strong>Count ofCasesAvg. Weeks:Book<strong>in</strong>g to<strong>Surgery</strong>Count ofCasesAvg. Weeks:Book<strong>in</strong>g to<strong>Surgery</strong>Authority(ID)IHA 1,887 12 876 2 3,274 6FHA 1,953 12 770 3 5,217 7VCHA 2,575 10 1,275 2 3,604 7VIHA 2,306 13 407 2 2,202 7NHA 2,512 11 346 3 1,985 6IHA 728 13 714 3 664 6FHA 605 7 1,065 3 1,120 8VCHA 558 11 879 4 1,051 9VIHA 1,073 23 704 3 745 8NHA 619 6 162 3 200 6
SON <strong>Wait</strong> <strong>Times</strong> Work<strong>in</strong>g Group:• Identified and agreed to report (based on CAPCArecommendations):• 90 th percentile <strong>in</strong> addition to the Median WT• Reports to list “calendar days”• Percent of patients to undergo surgery with<strong>in</strong> 14, 28 and 84 days• Identified referral to surgery and decision to surgery <strong>in</strong>tervals• Report trends on a monthly, quarterly and annual basis• RHA and cross-boundary volumes• SON now contributes to SPR committees• Works with SPR to streaml<strong>in</strong>e the report<strong>in</strong>g processes• Improve the type and quality of data captured
Cl<strong>in</strong>ical Practice Committee:a) Evaluation of the current data collection- determ<strong>in</strong>e which <strong>in</strong><strong>for</strong>mation should be <strong>in</strong>cluded- consultation / feedback - Surgical Tumor Groups- survey SON membersb) Propose a new Assessment Tool- propose a cancer specific Assessment Tool- generic or tumor specific- consultation / feed-back <strong>for</strong>m SON membersc) Review and edit the New Tool- propose the newly developed tool to SPR and MoHd) Validate and Implement
<strong>Cancer</strong> SpecificAssessment Tool• Is it necessary?• how should it look?• should we have cl<strong>in</strong>ical stage?• what are you <strong>in</strong>terested <strong>in</strong>?
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