Long Surgical Waiting Lists Lead to Delayed Care Across Canada

Across Canada, patient experiences with surgical delays and long wait lists are equally common, particularly for non-life-threatening procedures such as hip and knee replacements. . Patients may wait months – or even a year or more – for a surgical consultation. After that, they may have to wait another year for their procedure.

In the meantime, patients tend to experience increased pain, reduced quality of life, and negative effects on their personal and professional lives. Faced with unbearable waits, some patients choose to leave public health services for private medical facilities. In this way, patients end up getting the care they need but spend their savings on costly procedures, travel and wasted work time.

The province’s health services are looking for solutions, including public and private options, to deal with the disruption that has existed since before the COVID-19 pandemic. Population growth, the growing needs of an aging population, and shrinking supply among a shrinking workforce are contributing to a crisis that has been going on for more than a decade.

“In Canada, as in many countries, there are increasing demands on the health care system, there [satisfying] “The needs of a growing and aging population will continue to be a challenge,” said Sean Cleary, MD, chair of general surgery at the University of Toronto, Toronto, Ontario, Canada, and past president of the Society of Canada’s General Practitioners, he said. Medscape Medical News.

“We’ve been talking about wait times and capacity for a long time, and we’re continuing to look at ways to improve performance,” he said. “How do we provide care that is appropriate, appropriate and effective? There is no magic solution, so we have to keep pushing ourselves. ”

Recent Surgical Cases

To measure progress toward shorter wait times, the Canadian Institute for Health Information (CIHI) looks at annual changes in surgery numbers, hip fracture surgery within hours 48, and combined waiting times.

Surgery numbers returned to pre-pandemic levels in 2022-2023, when 2.22 million procedures were performed. The number has increased to 2.33 million in 2023-2024, marking a 5% increase from 2019-2020, according to a CIHI report released in late October.

Although more surgeries are being performed, waiting times remain longer than is considered acceptable, especially for hip and knee replacements, which are among the three surgeries that can the most common patient topic in Canada. In 2023, approximately 62% of these operations fell within the 26-week waiting period. The proportion ranged widely from 28% in Prince Edward Island and 36% in Saskatchewan to 60% in Britain Columbia and 77% in Ontario.

“Nationally, waiting times for most procedures reported remain longer than pre-pandemic levels, although the number of procedures has returned to pre-pandemic levels,” said Cheryl Chui, director of health systems analysis at CIHI.

“Delaying surgery can lead to negative health outcomes, including worsening health conditions, increased pain, and even death,” he said. “Addressing these delays is critical to improving patient outcomes.”

The private costs of these public lines for necessary medical care may increase, according to a recent report from the Fraser Institute, Vancouver, British Columbia, Canada. For example, by 2023, the estimated cost of waiting for care in Canada was $3.5 billion, or about $2871 for each of the 1.2 million Canadians waiting for treatment last year.

Fraser Institute researchers found that national wait times from a general practitioner to a referral for treatment were nearly 28 weeks by 2023, up from 9 weeks in 1993. Furthermore, the time to the wait from specialist doctor to treatment was 13 weeks, which is about a month long. more than what doctors considered medically reasonable, about 8 weeks.

“That said, context matters. Even in 2019, Canadian patients waited 19.8 weeks between referral and treatment. In other words, wait times are a structural issue exacerbated by the pandemic this,” said Bacchus Barua, co-author of the study and director of health policy studies at the Fraser Institute.

However, “long wait times for care are not a necessary price to pay to maintain a universal health care system. There are at least 30 other countries with more that share the goal of global health,” he said. “Unfortunately, the current approach in Canada is focused on the preservation of the [current] system, the patient is left to bear the consequences.”

Tests Solution

The COVID-19 pandemic has reduced access to patients and increased the fatigue of health workers. Provinces have tried different solutions to increase the volume of operations, reduce waiting times, and build health workers – with varying degrees of success.

For example, in Alberta, Canada, the Alberta Surgical Initiative was created to address the backlog of surgery and reduce wait times for non-life-threatening procedures. During that time, many health providers moved from public systems to private surgeries, which increased access problems. New public-private partnerships are expanding the use of surgical centers to provide community-supported procedures, and a centralized participation program is helping to increase the experience of surgeons in a short period of time. to wait. However, waiting lists remain long as demand continues to be high.

In Ontario, nonsurgical wait times for similar procedures vary widely between hospitals — by as much as 15 percent in some areas — according to a study published in PLOS ONE in August. The authors suggested adopting a centralized referral system, which could reduce the first part of the waiting list, as well as groups of surgeons for routine procedures, which could consolidate availability and reduce the second part of waiting list.

“Many provinces are taking similar measures to deal with long wait times,” Chui said. “The most important strategy is central intake, where all patients are placed on the same list and have the option of waiting for a specific doctor or taking the first available surgeon.”

Provinces also manage operating room schedules to increase capacity, monitor waiting lists to ensure the right patients are on their lists, and use centralized case managers to schedule surgeries, he said. Communication with patients and relevant stakeholders is also important.

“Importantly, patients will continue to wait for surgery without help, and this time it is stressful for patients. Changing the waiting time as an opportunity to prepare for surgery (prehabilitation) can improve the clinical outcomes of patient (mental and physical health) and the patient experience, which can reduce the burden on the health care system, “said Khara Sauro, PhD, associate professor and health services research at the University of Calgary, Calgary, Alberta.

Sauro and colleagues investigated surgical delays before and during the epidemic across several Canadian provinces. Although some issues are being clarified now, he noted, surgery wait times were a problem before the outbreak and remain an issue today.

“We cannot fix what we cannot measure, so it is important to continue to monitor and understand the waiting times for surgery so that we can adapt to the needs of the population,” said Sauro. “However, we need to go beyond measurement and use evidence to inform change. Times of crisis bring new trends – this is a great opportunity for policy makers, health care providers and beauty and researchers to work together to find a solution to the long-term wait for surgery.”

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape Medical News, MDedge, and WebMD.