Download wait time for cancer surgery

Canadian Institute for Health Information
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Emerging Wait Times
Indicators
Updated May 2012
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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
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Cancer Surgery Wait Times
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Background
In spring 2011, provinces developed a proposal for a
cancer surgery wait time indicator, using three guiding
principles:
1. 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.
2. 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.
3. 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
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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).
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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
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Prostate Cancer Wait Time Indicator
• Includes resections (partial or complete) of the
prostate for proven or suspected cases of cancer
• Includes pelvic node dissection
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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
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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)
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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
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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
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Includes those age 18 and older
•
Excludes obstetrics
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Excludes routine follow-ups
•
Excludes emergency patients
Decisions/Rationale
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Obstetrics scans are typically scheduled for set times so these patients do not “wait” for their scan
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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
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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.
Key Events Characterizing an ED Visit
Registration/Triage
Time to Physician Initial
Assessment (TPIA or TWIA)
VD = 02,03
VD = 02
PIA
Time waiting for
inpatient bed—
other unit (TWIB)
Time waiting for
inpatient bed—CCU
and OR (TWIB)
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
Emergency Department
Length of Stay (ED LOS)
Time to Disposition (TtoD)
ED LOS incorporates TWIB if the
patient is admitted (VD = 06, 07), or
an equivalent duration if waiting for
transfer (VD = 08, 09).
Left ED
= Records with the stated Visit Disposition are
excluded from the calculation.
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.
Arrival
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.
Data Elements for Time to Disposition
Data Element
Visit Disposition
Definition
-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
Data Element
Disposition Date/Time
Definition
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
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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
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Includes those age 18 and older
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Includes new referrals (new referrals occur when a referral letter is generated by a general practitioner or other
specialist)
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Excludes patient unavailable days
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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.
Thank You!
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