Cutting surgical wait times for children

TheStar.com – opinion/editorialopinion
Published On Tue Jun 28 2011.   James G. Wright

A group of Canadian pediatric surgeons has shown that we can measure waits for surgery using common, comprehensive and standard access targets in a pan-Canadian fashion.

We have also shown that this information is vital for clinicians and hospitals to manage surgical wait times for children, and that we can reduce wait times. Now we need a national plan to continue to collect this useful and vital information.

In 2007, the Prime Minister announced funding to initiate the Canadian Pediatric Surgical Wait Times (CPSWT) Project, which was designed to answer the question: Are Canadian children waiting too long for surgery?

What we found, as published in the Canadian Medical Association Journal on June 14, and the Wait Times Alliance Report Card on surgical wait times in Canada released on June 21, is that 28 per cent of children exceed acceptable wait times for surgery. And for procedures such as scoliosis surgery, that delay has real and detrimental effects on the surgical outcome.

Considering that there is no advantage to waiting — it saves no money and only delays essential care — the question now for all governments is how we should respond to almost 30 per cent of Canadian children waiting too long for surgery.

Lengthy waits not only prolong anxiety and suffering, but may have lifelong detrimental impact on health and development. Because CPSWT Project funding ended in March of this year, the first thing we must do is continue to collect this information though a national agency such as the Canadian Institute for Health Information. You cannot manage what you can’t measure.

We are off to a good start, as the CPSWT Project took an ambitious approach. More than 100 pediatric surgeons from across Canada, using expert consensus, developed the Pediatric Canadian Access Targets for Surgery (P-CATS). These access targets, attached to more than 850 diagnoses, provide a uniform approach to evaluating surgical waits, ensuring that children with the same diagnosis receive the same priority for surgery anywhere across Canada. Also, rather than focusing on a few areas, we developed access targets in all surgical disciplines, so that we could measure the wait for children’s surgery comprehensively.

In just under four years, across 15 academic and nine community hospitals across Canada, the CPSWT Project has measured the wait for surgery for more than 200,000 children. This has allowed us to follow trends, benchmark waits between peer hospitals and learn from each other.

Even more important, with this information we have managed wait lists at individual hospitals by better prioritizing patients and internally reallocating resources to maximize benefits for our patients.

In some provinces, such as Ontario, additional funding has enabled us to perform additional surgeries, thereby substantially reducing wait times for children. For instance, at the Hospital for Sick Children (SickKids) in 2007, 47 per cent of children exceeded their access targets but we are now at 15 per cent with an ultimate hope for a rate of zero.

And we have done more. We have completed a capacity analysis to understand the obstacles to performing more surgery. We have shared learnings on improving efficiencies. We have developed practice guidelines to clarify the most appropriate candidates for the surgical treatment of cryptorchidism (undescended testicles), a common condition affecting long-term fertility. In 2009, the accomplishments of the CPSWT Project were acknowledged with the Gold Leadership Award by the Institute of Public Administration of Canada.

We have a solid foundation, but we need a national plan to continue this essential work. Our next generation depends on it.

Dr. James G. Wright is chair of the pediatric surgical chiefs of Canada, leader of the CPSWT project and surgeon-in-chief at SickKids.

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