Yeah, I don't like hearing this at all.

Of course, if there is a lack of uniform and timely information on wait times,  how does anyone come up with these figures?  To some extent, the anecdotes are at least as troubling.

Some things to consider:

1) Canadian provinces, especially Ontario, squeezed real hard in the 1990s.  This included closing down a lot of hospital capacity.  The satisfaction surveys have strongly suggested that the system was not as good at the end of the decade as at the beginning.

1a) Which was justified in part, of course, by the usual mantra that  hospitals are not so important, primary care is crucial, if primary care were better people wouldn't need the emergency room, etc.  

2) But there are all sorts of well-known reasons why, even if you have a real good primary care system, some people will show up in the emergency room who don't need to be there, anyway.  And a good triage system should have gotten to the cases referred to below even if there were some extra, non-emergent patients in the room.  So perhaps the hospital sector was squeezed too hard.  And perhaps the emphasis on primary care can hurt people when it becomes an excuse to cut other care.

3) Of course I'm sure someone will say that the waits would be shorter if the "unnecessary" referrals were eliminated.  But that doesn't explain the ERs, which are supposed to have triage systems.  

Best,
Joe White

-----Original Message-----
From: Anglo-American Health Policy Network [mailto:[log in to unmask]] On Behalf Of Shirley Johnson-lans
Sent: Friday, June 26, 2009 10:09 AM
To: [log in to unmask]
Subject: Re: Canadian wait times

What a downer, after decades of having my Canadian academic friends, including several research docs. at Stanford U. Med. School rave about the system.   

Shirley


----- Original Message -----
From: A. Tawfik-Shukor <[log in to unmask]>
To: [log in to unmask]
Sent: Thu, 25 Jun 2009 17:10:55 -0400 (EDT)
Subject: Canadian wait times

FYI - Average 23 hour wait time in Canadian emergency depts.

In the past two years alone, I've had my friend's father die in the
emergency dept after an 18 hour wait (the doctor on duty left without notice
and there was nobody there), my best friend's wife had a miscarriage in
emerg after a 7 hour wait, and my father had to wait 9 months for a
routine hernia operation that went awefully wrong (they've told him to walk
off the pain).

Where's the accountability in this ''system''? The state of our primary care
system is a disaster, and there is virtually no quality oversight here
whatsoever. Nobody seems to give a damn - not our politicians, doctors,
hospitals, or patient groups (they don't seem to exist here) - nobody. I'm
truly ashamed of this.


*Canada's Wait Times "Exceed" Benchmarks
From Canada's Wait Time Alliance for Timely Access to Health Care's 2009
annual report "Unfinished Business: Report Card on Wait Times in Canada":*

Five years ago the governments of Canada resolved to improve wait times for
health care by committing nearly $6 billion to the cause. Although there are
signs of improvement, the lack of uniform and timely information on wait
times is just one symptom of the 'unfinished business'relating to wait times
in Canada. What's going on?

■ Based on the UK's National Health Service target of 18-weeks from initial
referral by a family physician to start of treatment, a majority of Canadian
patients had wait times that exceeded the 18-week target. Access is
particularly poor for: ophthalmology (adult strabismus), obstetrics and
gynecology, gastroenterology, plastic surgery and orthopedics.

■ The median wait for radical (curative) cancer care was 46 days or nearly 7
weeks and the majority of these treatments exceeded the Canadian Association
of Radiation Oncology benchmark for curative cancer treatment of 4 weeks (2
weeks for the consult wait and 2 weeks for treatment). This is troublesome
given the clear link between a delay in radiation therapy and a chance of
cure.

■ The study found that the median wait time from the time the patient
presented at the Emergency Department to the time the patient was discharged
(i.e., the patient did not need to be admitted to an inpatient bed) was
almost 6 hours, while the average wait was nearly 9 hours, both much longer
than the benchmark of 4 hours.

Moreover, the median wait time for patients requiring an inpatient bed-that
is, from the time the patient presented at the ED to the time they were
admitted to an inpatient bed-was 19 hours (*average is 23.5 hours* or nearly
one full day), which is substantially higher than the established thresholds
(e.g., more than three times the 6 hour guideline for high-level acuity
patients). The longer wait for patients to be admitted is often due to the
inability to find an available hospital inpatient bed.