Meeting the challenge of reducing waiting times for surgery.

T article by Snider and associates in the current issue of the Journal (Can J Surg 2005;48:35560) tackles the thorny issue of waiting for access to care in Canada’s public health system. In their study, the investigators surveyed patients who waited for total hip or knee arthroplasty in both community orthopedic practice and an urban academic tertiary care setting. Significantly, over half the patients waited longer than 9 months for surgery. There was also regional disparity in access to consultation, with urban patients waiting longer. Patient acceptance was low: half the patients expressed discontent with the waiting time. Although objective measures of functional deterioration were not studied, overall 47% of patients perceived that waiting significantly contributed to a deterioration in their health. This article is a timely reminder of the eroding confidence of the public, who believe their health care system is falling short of providing access to quality service in a timely fashion. A September 2004 “10-year plan to strengthen health care identified this serious shortfall and recommended a multibillion dollar investment to reduce wait times by increasing the training of health professionals, clearing backlogs, building capacity, improving community care and developing tools to manage wait times. Five clinical areas of priority were identified: joint replacement surgery, cancer, heart disease, diagnostic imaging and sight restoration. An aggressive timeline for developing indicators of access for health care and evidence-based benchmarks for medically acceptable wait times has been targeted for December 2005. What progress has been made? Since the September 2004 proposal, 2 significant initiatives have moved us toward a more equitable system. The Association of Canadian Academic Healthcare Organizations (ACAHO), as a leader in education for new health professionals and innovation in practice through health research, reported a number of strategies to develop and implement solutions for preventing prolonged wait times in the publicly funded health service. Particularly useful was progress in prioritizing patients for cardiac surgery, joint replacement or diagnostic imaging and the adoption of evidence-based urgency scoring tools such as those developed by Western Canada Waiting List Project and the Saskatchewan Critical Care network. A second initiative was a discussion initiated by the Wait Time Alliance (WTA), consisting of 6 medical specialties and the Canadian Medical Association, which reported provisional benchmarks for wait times by specialty, first principles for medically acceptable wait times and some subsequent steps for action. On June 9, 2005, the Supreme Court of Canada released its historic decision on the Chaoulli–Zeliotis case for the importance of decreasing wait times for publicly funded health service. In August 2005 the WTA released its final report with strategies to improve timely access to care, which goes a long way to addressing issues identified by Snider and associates and which has implications for surgeons. Surgeons need to be active participants in the definition of wait-time Coeditors Corédacteurs