Canadian Institute for Health Information

Emerging Wait Times Indicators Updated May 2012

Context CIHI has worked in collaboration with provinces to develop the following indicators: Cancer surgery wait times Diagnostic imaging wait times (PETScan and Ultrasound) Emergency department (ED) wait times Specialists wait times

Cancer Surgery Wait Times

Background In spring 2011, provinces developed a proposal for a cancer surgery wait time indicator, using three guiding principles: Consistency with the original Comparable Indicators of Access Sub Committee (CIASC) definitions for surgical waits. To ensure cancer surgery waits are comparable with other surgical wait times, the indicator must be achievable and measurable with a concrete trigger to start the wait segment. Indicator must be useful for both provincial accountability and clinical reporting. Developing an indicator that meets global needs is important to avoid multiple versions of the “truth” and a lack of comparability in the future. Collaborative development process using knowledge from provinces presently reporting on cancer surgery waits.

Cancer Surgery Wait Time Indicator Definition The wait time for cancer surgery (proven or suspected) is the number of days that patients waited between the booking date and the date of surgery/biopsy. Summary Measures 50th percentile, 90th percentile Body Sites The wait times for cancer surgery will be reported at a provincial level by the following body sites: Breast Prostate Colorectal Lung Bladder

Cancer Surgery Wait Time Indicator General Inclusions All surgeries for proven* and suspected† cases will be included. General Exclusions Patient unavailable days‡ Biopsies completed outside of a main hospital operating room Patients on neo-adjuvent therapy—excluded from wait time calculation Emergency cases—excluded from wait time calculation * Proven cases are those with a confirmed pathology report. † Suspected cases are those without a confirmed pathology report. ‡ Patient unavailable days are delays in surgery that are patient-initiated (for example, vacation) or clinically-initiated (for example, medically not stable for surgery).

Breast Cancer Wait Time Indicator Includes all mastectomies, resections, excisions and lumpectomies for proven or suspected cases of cancer Includes breast and sentinel node biopsies when combined with surgery procedures listed above for patients who have a proven or suspected cancer Excludes BRCA 1 and 2 mutations Excludes breast reconstruction surgery unless done in the same operating room (OR) episode

Prostate Cancer Wait Time Indicator Includes resections (partial or complete) of the prostate for proven or suspected cases of cancer Includes pelvic node dissection

Colorectal Cancer Wait Time Indicator Includes all resections of the colon by incision or scope performed in an OR (large intestine including cecum, ascending, transverse, descending and sigmoid) and rectum (does not include small intestine) for proven or suspected cases of cancer Includes ileostomy/colostomy for proven or suspected cancer Excludes closure of ileostomy/colostomy Excludes cancer of the stomach or small intestine Excludes diagnostic scopes

Lung Cancer Wait Time Indicator Includes thoracotomy for suspected or proven cancer with resection (partial or complete) of lung(s) Excludes bronchoscopy/mediastinoscopy (the general definition includes only ablative or palliative surgery)

Bladder Cancer Wait Time Indicator Includes resections (partial or complete) of the bladder with or without fulguration Includes cystectomy with or without ileo conduit for proven or suspected cases of cancer Excludes cystoscopy as a diagnostic procedure

PET Scan and Ultrasound Wait Times

PET and Ultrasound Wait Times Indicator Definition The number of days a patient waited from the date the order/requisition was received to the date the patient received the positron emission tomography (PET)/ultrasound scan. Summary Measure The summary measures for PET scan and ultrasound wait times will be 50th percentile and 90th percentile. Population Includes those age 18 and older Excludes obstetrics Excludes routine follow-ups Excludes emergency patients Decisions/Rationale Obstetrics scans are typically scheduled for set times so these patients do not “wait” for their scan Follow-up appointments are typically scheduled. Some provinces are unable to separate out routine follow-ups. There is a high proportion of no-shows and rescheduled appointments across all of the provinces; given the large volume of scans, it is not possible to delete patient unavailable days as with other priority procedures. However, most provinces are able to adjust the wait times data by removing the names of patients who initiate delays, and those who are currently unable to do so agree in principle that they should be removed. Provinces will move towards excluding patients who reschedule their appointment. Where this is not possible, an exception will be noted.

Emergency Department Wait Time

ED Wait Time Indicator Definition Date/time between registration date/time or triage date/time (whichever occurs first) and date/time of physician initial assessment. Summary Measure The summary measures for ED wait times will be 50th percentile and 90th percentile. Population May be reported for all patients, by triage level or by visit disposition. Exclusions Does not include registered patients who left without being seen or triaged, or triaged patients who left before further assessment or after treatment was initiated. Does not include patients discharged home, death, intra-facility transfers to day surgery, clinic, or ED, or transfers out of the reporting facility. Definition: Emergency patients are those who must be seen within 48 hours of a referral being generated. Any consultations with a specialist requested and delivered outside of 48 hours are to be included in reporting of waits for specialist care. Inpatients should be included in this group when a referral is generated in hospital for an external consult. Referrals can be generated by a GP, emergency room physician, or physician specialist.

Key Events Characterizing an ED Visit PIA Arrival Registration/Triage Time to Physician Initial Assessment (TPIA or TWIA) VD = 02,03 Emergency Department Length of Stay (ED LOS) Each ED visit can be described as a sequence of timed events; the ED Times indicator reports communicate the median and 90th percentile duration of these intervals. Disposition Disposition is the end point for ED LOS if the patient is neither admitted (VD = 06, 07) nor transferred (VD = 08, 09) Time to Disposition (TtoD) VD = 02 Time waiting for inpatient bed—CCU and OR (TWIB) Time waiting for inpatient bed—other unit (TWIB) Admitted Left ED ED LOS incorporates TWIB if the patient is admitted (VD = 06, 07), or an equivalent duration if waiting for transfer (VD = 08, 09). VD = 01–05,07–15 VD = 01–06,08–15 = Records with the stated Visit Disposition are excluded from the calculation.

Data Elements for Time to Initial Physician Assessment Definition Date/Time of PIA (Physician Initial Assessment) The date/time* the physician (first physician) first assessed the patient. Triage Date/Time The calendar date/time when the patient is triaged in the ED. Note the following Canadian Association of Emergency Physicians (CAEP) guideline: Triage should occur prior to registration. Triage Level The initial triage level (adult—CTAS; pediatric—PCTAS) for the patient on this visit. The triage level was developed by CAEP and applicable to patients seen in EDs. Date/Time of Registration/Visit The date/time when the patient presents for services to any ambulatory care functional centre and is officially registered as a patient. * Format for “date” is year/month/day ; for “time,” the format is hours and minutes.

Data Elements for Time to Disposition Definition Visit Disposition Admitted into reporting facility as an inpatient to CCU or OR directly from an ambulatory care visit functional centre Admitted into reporting facility as an inpatient to another unit of the reporting facility directly from the ambulatory care visit functional centre Transferred to another acute care facility directly from an ambulatory care visit functional centre (including another acute care facility with entry through ED) Transferred to another non–acute care facility directly from an ambulatory care visit functional centre (for example, stand-alone rehabilitation or stand-alone mental health facility) Death after arrival—patient expires after initiation of the ambulatory care visit Death on arrival—patient is dead on arrival at the ambulatory care service Intra-facility transfer to day surgery Intra-facility transfer to the ED Intra-facility transfer to a clinic

Data Elements for Time to Disposition Definition Disposition Date/Time The date/time* the main service provider makes the decision about the patient’s disposition Notes The best available marker for the Disposition Date is the date when the service provider issues the disposition order or request. It is the end point for an ED and/or day surgery visit. When Disposition Date is unknown and the patient is admitted, record the date/time the patient left the ED. * Format for “date” is year/month/day ; for “time,” the format is hours and minutes.

Specialist Care Wait Times

Specialist Care Wait Time Indicator Definition The number of days between the date the referral was sent and the date the patient was seen by a specialist Summary Measure The summary measures for specialist care wait times will be 50th percentile and 90th percentile. Population Includes those age 18 and older Includes new referrals (new referrals occur when a referral letter is generated by a general practitioner or other specialist) Excludes patient unavailable days Excludes emergency cases and in-hospital referrals Reviewed on April 19, 2011 Decision The indicator definition will be changed to the number of days between the date the referral was received in the specialist’s office and the date the patient was seen by a specialist. Rationale Operational challenges exist in capturing the date the referral was sent. Definition: Emergency patients are those who must be seen within 48 hours of a referral being generated. Any consultations with a specialist requested and delivered outside of 48 hours are to be included in reporting of waits for specialist care. Inpatients should be included in this group when a referral is generated in hospital for an external consult. Referrals can be generated by a GP, emergency room physician, or physician specialist.

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