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Wait Lists

B.C. surgical wait list in error by nearly 14 percent

VANCOUVER – An audit of British Columbia’s elective surgical wait list website found that 11,000 patients on a list of 80,000 shouldn’t be on it.

While that’s good news in terms of a reduced number of patients waiting for surgery, it raises questions about how to accurately collect and maintain data for such databases.

Dr. Penny Ballem, B.C.’s deputy health minister, said many patients have already had their surgery, changed their minds about having it, or had died while waiting. Of those who died, it is not known if their deaths were related to the planned surgery or not.

The B.C. government is pledging to rectify the nearly 14 percent error rate by unveiling an overhauled website by the end of the year.

A preliminary audit of the wait list website done late last year found that 6,000 patients on the list of more than 80,000 were there by mistake because hospitals, doctors and others who are submitting the data failed to remove names when patients were no longer waiting.

As the audit has continued, the government discovered the website actually overstated the number of those waiting by more than twice what it
originally thought.

As a result of the six-month review of the ministry’s various data sources, more than 10,000 patients have been identified who should no longer be on the existing Surgical Waitlist Registry. This includes:

• 33 B.C. women waiting more than a year for their C-sections.

• 24 people waiting more than 18 months for a blood transfusion.

• More than 1,000 people on the list who are shown in the Vital Statistics database to have passed away – some as long as five years ago (the vast majority were listed for non-life threatening conditions such as cataract surgery).

• More than 9,000 people on the wait list appear to have had their scheduled surgeries months or years ago.

In British Columbia, more than half of all surgeries are identified and done by physicians as emergency procedures. Under 50 percent are waitlisted and results indicate that of these:

• 10 percent are done within a week.

• 25 percent are done in less than two weeks.

• 50 percent are done in just over a month.

• 75 percent are done in just over three months.

• 90 percent are done in less than seven months.

More work is necessary to identify patients waiting over seven months, determine why their waits are inconsistent with the majority of patients and consider strategies to expedite their care.

According to the B.C. Ministry of Health, there have been significant improvements in access to surgery in priority areas identified by First Ministers in fall 2004. For example, from 2000/2001 to 2003/2004:

• Knee replacements increased by more than 33 percent.

• Hip replacements increased by more than 21 percent.

• Cataract surgeries increased by 20 percent.

• Coronary bypasses increased by 21 percent.

• Angioplasties increased by over 40 percent.

In December 2004, there were 55 percent fewer patients waiting for non-emergency cardiac surgery than in December 2002. The median wait time for cardiac surgery in B.C. has fallen from 16 weeks to less than nine, consistent with best practice. There is virtually no wait for access to cancer surgery, the ministry said.

In addition to the ministry’s efforts, all health authorities along with physicians from across B.C. are participating in a surgical services project through the Provincial Health Services Authority.

The project will develop and implement clinical tools for doctors to assess patients across several surgical specialty groups over the next year. B.C. is building on the foundation work of the Western Canada Wait List study as well as the Saskatchewan Surgical Care Network.

At the same time, B.C. is working to enhance and eventually replace the existing waitlist registry by developing a system that supports the physicians’ clinical assessment of their patients’ medical needs. This future registry is being designed with links to the hospital information system, to eliminate duplication and ensure that patients who have had their surgery are cleared immediately from the wait list.