Canadian Institute for Health Information

1. Canadian Institute for Health Information

2. Health Care in Canada, 2012:A Focus on Wait Times An Overview

3. Key Messages • Waits for family physicians are acceptable to majority of Canadians, even though they are long by international standards. Canadians are more likely to report challenges in waits for specialists. • Waits in Canadian emergency departments are longer than in other countries and longer than the ideal response times recommended by Canadian Association of Emergency Physicians. • Little evidence at the national level shows that a focus on priority surgeries has crowded out other procedures. Variation exists at provincial level, likely the result of jurisdictions pursuing different strategies to address local wait time and access to care issues.

4. Key Messages (cont’d) • Challenges persist for patients waiting for discharge from acute care, with ~5% of acute care beds occupied by someone waiting for services in a different setting. • Patients receiving specialized inpatient care (e.g. rehabilitation, mental health) also wait to move on to their next care setting. Those with the highest care needs and those waiting for residential care wait longest. 6. Moving forward, applying what we know works, better measurement, broad prevention efforts, and looking at waits from the patient’s perspective may help reduce wait times beyond identified priority areas.

5. Family Physician: Long Waits, Few Complaints • The majority (85%) of Canadians age 12 and older report having a regular family physician—but report waiting an average of two days to see one for routine or ongoing care. • In 2010, Canada ranked lowest internationally (with Norway) for wait times to see a doctor or nurse when sick.

6. Specialist Waits: Long and Unacceptable • In 2010, Canadians reported the longest waits for a specialist appointment (out of 11 countries). • In 2009, 50% of Canadians waited more than a month to see a specialist, with 10% waiting longer than three months. • The percentage waiting longer than three months rose to 14% in 2009 from 10% in 2003.

7. Canadians twice as likely to report waits for specialists as unacceptably long (compared with waits for family physicians)

8. Lengthy Waits in Canadian EDs • In a 2010 comparison of 11 countries, Canada had highest percentage of patients waiting four or more hours in an emergency department (ED) before being treated. • Canada also had highest percentage of ED visits in past two years. • In 2010–2011, overall average length of stay in ED was ~4.4 hours, with 90% of visits completed in eight hours. • Level of acuity and patient admission/non-admission affects time spent in the ED.

9. ED Waits Longer Than Recommended • Overall, and by Canadian Triage and Acuity Scale (CTAS) level, waits for a physician initial assessment are longer than ideal response times recommended by Canadian Association of Emergency Physicians. • Targets met for 50% of low-acuity cases (CTAS levels IV and V) • Targets not met for 90% of visits at any CTAS level *Adapted from Canadian Triage and Acuity Scale ImplementationGuidelines.

10. Little Evidence at National Level That Focus on Priorities Has Crowded Out Other Procedures . . .

11. . . . But Variation Among Jurisdictions, Especially in Last Three Years

12. Challenges for Patients Leaving Acute Care • ~5% of acute care beds occupied by patients waiting for more appropriate care settings—alternate level of care (ALC) stays • 16% waited 1 or 2 days • 21% waited >1 month • 5% waited >100 days • Among those most likely to wait are those with • Dementia (7%) • General signs and symptoms (5%) • Stroke (4%)

13. Specialized Care: Wait for Next Care Setting • In 2009–2010, adult inpatients spent 2.2 million days being treated for mental illness—23% were spent in ALC. • There is some evidence that patients with ALC days had more complex needs and challenges. • The most common discharge settings for mental health patients with at least one ALC day are • Continuing care (59%) • Home without (16%) or with (14%) services .

14. Specialized Care: High-Care Patients Wait Longest for Discharge • Patients with highest care needs and those waiting for residential care wait longest for discharge from rehabilitation. Waits for Discharge

15. Looking Forward • Findings from this report and review of literature suggest four key areas where system decision-makers could focus in the future to address continuing wait time challenges: • Implement proven strategies to help address known waits • Collect and report on comparable data across the care continuum, and evaluate waits against benchmarks • Promote broad prevention efforts to help reduce demand for health care services • Take patient-centred focus and improve coordination of care across the continuum

16. Strategies: Financial Incentives • Pay for Performance: B.C. • Compensation for Clinical Activities Performed by Pharmacists: Alta. • Emergency Room Wait Times Strategy: Ont. • Central Access Management Process: Que. • Billing for Clinical Geriatrics Assessment: N.S. • Additional Funding to ICU Physicians: N.S. • Shortening Wait Lists for Family Physicians: P.E.I.

17. Strategies: Human Resource Policies • EMS Offload Nurse Program: Ont. • Extended Care Paramedic Program: N.S. • Interprovincial Collaboration for Diagnostic Imaging: P.E.I., N.S. • Collaborative Model of Care: P.E.I. • Clinical Nurse Leader Role: Y.T. • Changing Directions, Changing Lives: National

18. Strategies: Technology, Patient Flow • My eHealth: B.C. • Telehealth Systems: B.C., Ont. • Advanced Access: B.C., Sask., N.B. • Emergency to Home: Alta. • Investment in Supportive Living Facilities: Alta. • ED Redesign: Sask. • Patient Access Registry Tool: Man. • Reducing ALC Days in a Rehabilitation Facility: Ont. • Centralized Approach for Joint Replacements: N.L. • Implementing Strategies From a Patient Flow Study: N.L.

19. About CIHI’s Health Care in Canada Series • Report published annually since 2000 • Brings together data and information from many sources for broad examination of significant issue(s) • Can access entire Health Care in Canada series at www.cihi.ca/hcic • For more information, send an email to healthreports@cihi.ca

20. Thank You