Wait Time Benchmarks Oversimplify Access and Ignore Wait One


Wait times reporting continues to garner much media attention in Ontario and across Canada. The recent report by the Canadian Institute for Health Information shows that on the whole Canada is doing a decent job meeting benchmarks for select surgical procedures and diagnostic scans. Ontario leads the pack, with over 80% of patients getting hip and knee replacements, and hip fracture repairs, within the target benchmark. Sounds great? Unfortunately, a closer look at the data reveals important limitations.

The biggest limitation with this wait time data is that it captures only a small part of the patient journey. Specifically, this metric captures the time from booking the procedure to having the procedure. However, the patient journey begins with the onset of symptoms, and their decision to seek help from their family doctor. Then, tests may be ordered, and at some point the doctor and patient will decide to consult with a specialist, entering what is called “wait one”.

Wait one is an important part of the overall wait time for three important reasons. First, it is entirely passive in that neither the family doctor nor the patient can do anything but wait. Second, it is an opportunity for patients to fall through the cracks and for the system to lose their referral. There are highly-publicized, tragic cases, but yet this is also mundane – a study in Hamilton revealed that 21% of referrals get lost at this point. Third, this is an important source of patient anxiety due to a combination of the above factors, and our own surveys of patients support this view.

Until now, capturing wait one has been a tremendously cumbersome process. However, in the 9 months that ConsultLoop’s e-referral network has been active, we have been measuring all phases of wait one at a very granular level. For example, we not only know the wait time for each individual referral or appointment, but we can also tell how long it took for the specialist’s office to book the appointment, and even how long it was until the patient was notified. Insight at this level also allows us to measure key aspects of the patient experience, and this is the first step to improvement. In fact, we propose that since this is now possible, any health system must have such wait time and access surveillance capabilities in place.

ConsultLoop applauds efforts to measure wait times, but it’s important to remember that for patients, any measurements that ignore wait one ignore a key part of their health care experience.


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