Download Wait Time Information in Priority Areas: Definitions

Wait Time Information in Priority
Areas: Definitions
1
Background
• In 2004, Canada’s first ministers agreed to work
towards reducing wait times for five priority areas:
cancer treatment, cardiac care, diagnostic imaging,
joint replacement and sight restoration. CIHI was
mandated to collect wait times information and
monitor provincial progress in meeting benchmarks.
• Since 2004, CIHI and the provinces have
collaboratively worked towards the development
of indicators and public wait times reporting
for five priority procedures and two diagnostic
imaging procedures.
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Background
• In 2005, the Comparable Indicators of Access Sub
Committee (CIASC) developed a pan-Canadian
definition for wait time measurement which was
adopted by the federal/provincial/territorial ministries.
• The definition of start date for wait time measurement
was defined as follows: “Waiting for a health service
begins with the booking of a service, which is when
the patient and the appropriate physician agree to a
service, and the patient is ready to receive it.”
• The definition of finish date for wait time measurement
was defined as follows: “Waiting for a service ends
when the patient receives the service, or the initial
service in a series of treatments or services.”
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Procedures for which wait times
information is currently being reported
• Hip replacement
• Knee replacement
• Hip fracture repair
• Cataract
• Coronary artery bypass graft (CABG)
• Radiation therapy
• MRI
• CT
• Cancer surgery (breast, bladder, colorectal,
lung and prostate)
• IV chemotherapy (collection targeted for 2016)
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Procedures for which wait times information
is being considered for future reporting
• Diagnostic imaging wait times (PET scan and ultrasound)
• Emergency department (ED) wait times
• Specialists wait times
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Reporting for hip replacement
As of 2010, the following definition and population have been applied to CIHI’s
reporting for hip replacement surgery wait times:
Definition
The number of days a patient waited, between the date when the patient and the appropriate physician agreed to a total
hip replacement surgery and the patient was ready to receive it, and the date the patient received a planned total hip
replacement surgery.
Benchmark
Within 26 weeks (182 days)
Time frame
April 1 to September 30, annually
Population
• Includes those age 18 and older
• Includes all total hip replacements (primary and revision); bilaterals count as a single wait
• For all priority levels
• Excludes emergency cases
• Excludes elective partial hip replacements and hip-resurfacing techniques
• Excludes days when the patient was unavailable
Decisions/rationale
• The inclusion of bilateral hip replacements, patients younger than age 18, and/or out-of-province patients are not
material to the reported wait times for hip replacements. These are not reported as exceptions for provinces that are
unable to remove these cases from their data.
• Provinces continue to work towards removing “patient unavailable” days from reported wait times. This will continue
to be an area of variation which CIHI will note.
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Reporting for knee replacement
As of 2010, the following definition and population have been applied to reporting
for knee replacement surgery wait times:
Definition
The number of days a patient waited, between the date when the patient and the appropriate physician agreed to a total knee replacement
surgery and the patient was ready to receive it, and the date the patient received a planned total knee replacement surgery.
Benchmark
Within 26 weeks (182 days)
Time frame
April 1 to September 30, annually
Population
•
Includes those age 18 and older
•
Includes all total knee joint replacements (primary and revision); bilateral joints count as a single wait
•
For all priority levels
•
Excludes emergency cases
•
Excludes knee-resurfacing techniques
•
Excludes days when the patient was unavailable
Decisions/rationale
•
The inclusion of bilateral knee replacements, patients younger than age 18 and out-of-province patients are not material to the reported wait
times for knee replacements. These will not be reported as exceptions for provinces that are unable to remove these cases from their data.
•
Provinces continue to work towards removing “patient unavailable” days from reported wait times. This will continue to be an area of
variation which CIHI will note.
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Reporting for hip fracture repair
As of 2010, the following definition and population have been applied to reporting for hip
fracture repair wait times:
Definition
1. Measured from the time of first registration at an emergency department with hip fracture (index admission) to the
time when hip surgery was received.
AND/OR
2. Measured from the time of first inpatient admission with hip fracture (index admission) to the time when hip surgery
was received.
Benchmark
Within 48 hours
Time frame
April 1 to September 30, annually
Population
•
•
•
•
Ages 18 and older
Discharge from an acute care institution
Admission category recorded as emergent/urgent (if wait from first inpatient admission)
Excludes in-hospital hip fractures
Decisions/rationale
• In-hospital hip fractures are excluded as the time of the fracture or start of wait is not known.
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Reporting for cataract surgery
As of 2010, the following definition and population have been applied to reporting
for cataract surgery wait times:
Definition
The number of days that patients waited, between the date when the patient and the appropriate physician agreed to a cataract
surgery and the patient was ready to receive it, and the date the patient received a planned cataract surgery.
Benchmark
Within 16 weeks (112 days)
Time frame
April 1 to September 30, annually
Population
• Ages 18 and older
• For first eye only; bilateral cataract removal counts as a single wait
• For all priority levels
• Excludes emergency cases
• Excludes days when the patient was unavailable
Reviewed April 19, 2011
Decisions/rationale
• CIHI will note the cases that have been included in which a procedure has been performed on the second eye.
• There is no universal definition for high-risk cataract surgery procedures across provinces, hence, they are not consistent across
jurisdictions. CIHI will note where high-risk patients are included.
• Inclusion of out-of-province patients is not material to the reported wait times for cataract surgery. These are not reported as
exceptions for provinces that are unable to remove these cases from their data.
• Provinces continue to work towards removing “patient unavailable” days from reported wait times. This will continue to be an area
of variation which CIHI notes.
Rationale for inclusion of first eye only: Provincial start times for the wait for cataract surgery for the second eye vary (booking
date, DTT, time of first surgery). About 40% of all cataract surgery procedures involve the second eye. Taken together, including this
wait will likely materially affect reported waits.
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Reporting for coronary artery bypass graft
surgery (CABG)
As of 2011, the following definition and population have been applied to reporting for bypass
surgery wait times:
Definition
The number of days that patients waited, between the date when the patient and the appropriate physician agreed to
a coronary artery bypass graft (CABG) and the patient was ready to receive it, and the date the patient received a
planned CABG.
Benchmark
Within 2 to 26 weeks (14 to 182 days), depending on how urgently care is needed.
Time frame
April 1 to September 30, annually
Population
• Includes those age 18 and older
• Includes Isolated CABG only
• For all priority levels
• Excludes emergency cases
• Excludes days when the patient was unavailable
Decisions/rationale
• The inclusion of out-of-province patients and those younger than age 18 is not material to the reported wait times for
bypass surgery. Inclusion of these patients will not be reported as an exception.
• Provinces continue to work towards removing “patient unavailable” days from reported wait times. This will continue
to be an area of variation which CIHI notes.
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Reporting for radiation therapy
As of 2011, the following definition and population will apply to reporting for radiation
therapy wait times:
Definition
The number of days that patients waited, between the date the patient is “ready to treat” and the date of the first
radiation therapy treatment.
Benchmark
Within 4 weeks (28 days) of patient being ready to treat
Time frame
April 1 to September 30, annually
Population
• Includes adults (those age 18 and older)
• All referrals to start or initiate radiation treatment
• All priority levels and all cancer types rolled up
• Excludes days when the patient was unavailable
• Includes oncology planning time
Reviewed April 19, 2011
Provinces that include radiation treatments other than external beam are noted in the exceptions.
Decisions/rationale
• Pediatrics and emergency patients are included as their inclusion is not material to the reported wait times for
radiation therapy. The inclusion of these patients will not be reported as an exception for those provinces that do
report in this manner.
• All referrals to start or initiate treatment may include patients who have had previous radiation treatment for the same
or other cancers, patients who have metastases from a previous cancer and/or palliative patients.
• Provinces that include radiation treatments other than external beam will be noted in the exceptions.
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Reporting for CT and MRI scans
As of 2010, the following definition and population have been applied to reporting
for CT and MRI wait times:
Definition
The number of days that patients waited, between the date the order/requisition is received and the date of
the date the patient received the scan.
Time frame
April 1 to September 30, annually
Population
• Includes adults (those age 18 and older)
• Includes diagnostic scans (may be inpatient and/or outpatient)
• For all priority levels
• Excludes routine follow-up scans
• Excludes mammography screening and prenatal screening
Decisions/rationale
• The inclusion of emergency patients is not material to the reported wait times for diagnostic imaging. These will not
be reported as an exception.
• Routine follow-up scans are material to reported wait times as they comprise between10% and 15% of all cases and
typically might occur at a six-month or annual cycle and would contribute to long “waits” if left in. Several provinces
are able to identify routine follow-up scans via a flag in their databases. For those unable to identify follow-ups, CIHI
will note this as an exception.
• Mammography screening and prenatal screening will not be included in the population and will be noted in
the population.
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Reporting for general cancer surgery
As of 2014, the following definition and population will apply to reporting for cancer
surgery wait times:
Definition
The number of days that patients waited, between the date when the patient and the appropriate physician agreed to a
cancer surgery and the patient was ready to receive it, and the date the patient received a planned cancer surgery.
Time frame
April 1 to September 30, annually
Population
• Includes all surgeries for proven and suspected cancers
• All surgeries for palliative patients are included
• All cancer surgery for new and recurrent/metastatic cancers will be included
• Excludes days when the patient was unavailable
• Excludes patients who received a biopsy as the sole procedure
• Excludes patients on neo-adjuvant therapy
• Excludes emergency cases
Decisions/rationale
• Suspected cases are included because a pathology report may not be completed before surgery and data collection
limitations do not allow for accurate collection of pathology results.
• Surgical treatment for palliative patients and recurrent cancers are included because it competes for operating room
time the same as newly diagnosed cancer patients.
• Provinces unable to exclude biopsies as a sole procedure will be noted in the exceptions.
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Reporting for breast cancer surgery
In addition to the general exclusions for cancer surgery, the following definition
and population will apply to reporting for breast cancer surgery wait times:
Population
• Includes all mastectomies, resections, excisions and lumpectomies for proven or suspected cases of cancer.
• Includes breast and sentinel node biopsies when combined with surgeries listed above for patients that have a
proven or suspected cancer.
• Excludes BRCA 1 and 2 mutations.
• Excludes breast reconstruction surgery unless done in the same operating room session.
Decisions/rationale
• Treatment for BRCA 1 and 2 mutations are considered to have different needs than those with suspected or
confirmed cancer and are therefore excluded. Provinces unable to BRCA 1 and 2 mutations will be noted in
the exceptions.
• Reconstruction cases will be excluded for the same reason noted in the previous bullet. However if provinces
are unable to remove these cases, they are not likely to materially affect the waits and no provincial exception
will be noted.
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Reporting for bladder cancer surgery
In addition to the general exclusions for cancer surgery, the following definition and
population will apply to reporting for bladder cancer surgery wait times:
Population
• Includes resections (partial or complete) of the bladder with or without fulguration.
• Includes cystectomy with or without ileal conduit for proven or suspected cases of cancer.
• Excludes cystoscopy as a diagnostic procedure.
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Reporting for colorectal cancer surgery
In addition to the general exclusions for cancer surgery, the following definition and
population will apply to reporting for colorectal cancer surgery wait times:
Population
• Includes all resections of the colon by incision or scope performed in an operating room (large intestine including
cecum, ascending, transverse, descending and sigmoid) and rectum (does not include small intestine) for proven or
suspected cases of cancer.
• Includes iliostomy/colostomy for proven or suspected cancer.
• Excludes closure of iliostomy/colostomy.
• Excludes cancer of the stomach or small intestine.
• Excludes diagnostic scopes.
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Reporting for lung cancer surgery
In addition to the general exclusions for cancer surgery, the following definition and
population will apply to reporting for lung cancer surgery wait times:
Population
• Includes thoractotomies for suspected or proven cancer with resection (partial or complete) of lung(s) .
• Excludes bronchoscopies/mediastinoscopies.
Decisions/rationale
• Bronchoscopy/mediastinoscopy for diagnosis was excluded as most lung cancer is diagnosed using various
diagnostic imaging modalities.
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Reporting for prostate cancer surgery
In addition to the general exclusions for cancer surgery, the following definition and
population will apply to reporting for prostate cancer surgery wait times:
Population
• Includes complete resection of the prostate for proven or suspected cases of cancer.
• Includes pelvic node dissection.
• Excludes trans-urethral resection of the prostate.
Decisions/rationale
• Includes pelvic node dissection, as it is part of determining the treatment pathway for patients with less
differentiated tumors.
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Reporting for IV chemotherapy
(collection targeted for 2016)
Ready to treat to first treatment*: The wait time for IV chemotherapy treatment is the number of
calendar days a patient waited, between the date the patient is ready to treat and the date of the first
IV chemotherapy treatment (day 1, cycle 1).
Referral-to-consult: The number of days a patient waited, between the date the referral from family
physician or specialist was received and the date the patient was seen by an oncologist for the
first time.
Consult-to-treatment: The number of days a patient waited, between the date the patient sees the
oncologist for the first time and the date of the first IV chemotherapy treatment.
Summary measures: 50th percentile, 90th percentile
Body sites: Breast, colorectal, lung
* It was agreed that the “RTT to first treatment” wait time will be the common starting point when
provinces are ready to begin collecting and reporting.
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Reporting for IV chemotherapy
(collection targeted for 2016)
Population
• Ages 18 and older
• Includes IV chemotherapy only
• Only includes first dose of IV chemotherapy treatment for both patients
with a new diagnosis of cancer and recurrent cancer
• Includes planning time
• Excludes supportive and hormonal therapy
• Excludes multiple rounds
• Excludes emergency patients who have a life threatening condition or
require immediate assessment and treatment
• Excludes inpatient cases
• Excludes patient unavailable days
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IV chemotherapy: Patient pathway
Planning time: Defined as all activities that occur prior to treatment and that are part of the system
response such as: patients waiting for IV PICC line or Portacath insertion, a chemo chair, approval
of medications, and alternative options for treatment, among others. Patient caused delays are not
part of the planning time definition and are excluded (if known) from the wait time calculation.
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PET scan and ultrasound wait times
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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.
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Emergency department wait times
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ED wait time indicators
Definitions
• Time of Physician Initial Assessment (TPIA): The time interval between the earlier of triage date/time or
registration date/time* and date/time of physician initial assessment
• Time to Disposition (TtoD): The time interval between the earlier of triage date/time or registration date/time*
and the disposition date/time (as determined by the main service provider)
• Time Waiting for Inpatient Bed (TWIB): The time interval between the disposition date/time (as determined by
main service provider) and the date/time patient left ED for admission to an inpatient bed or operating room
• ED Length Of Stay (LOS): The time interval between the earlier of triage date/time or registration date/time*
and one of the following times: date/time patient left ED for admitted or transferred patients or disposition
date/time for all other visit dispositions
Summary measures
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.
Inclusions/exclusions
• * Depending on the acuity of the case or hospital procedures, triage may occur before registration; therefore, the
earlier of these two events is used as the starting point. If either Triage Time or Registration Time is unknown
(time = 9999), the other can be used as a proxy.
• TPIA is not calculated for patients registered but left without being seen or triaged and patients triaged but left
before further assessment.
• TtoD is not calculated for patients registered but left without being seen or triaged.
• TWIB is only calculated for patients admitted into reporting facility as inpatient (CCU or OR or to another unit).
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Key events characterizing an ED visit
Time to Physician Initial
Assessment (TPIA)
Registration/triage
VD = 02,03
VD = 02
PIA
Time waiting
for inpatient bed
(TWIB) — other unit
Time waiting for
inpatient bed (TWIB)
— CCU and OR
Disposition is the end point for ED LOS
if the patient is neither admitted (VD =
06, 07) nor transferred (VD = 08, 09)
Disposition
VD = 01–
06,08–15
VD = 01–
05,07–15
Admitted
ED LOS incorporates TWIB if the
patient is admitted (VD = 06, 07), or
an equivalent duration if waiting for
transfer (VD = 08, 09).
Emergency
Department Length
of Stay (ED LOS)
Time to Disposition (TtoD)
Emergency Department
Length of Stay (ED LOS)
Arrival
Left ED
= Records with the stated Visit Disposition are
excluded from the calculation.
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Data elements for Time to Initial
Physician Assessment
Data element
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.
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Data elements for Time to Disposition
Data element
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
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Data elements for Time to Disposition
Data element
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.
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Specialist care wait times
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Specialist care wait time indicator
Definition
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.
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
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Thank you!
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