Waiting Too Long

I would like to commend the authors of the report Waiting Too Long: Reducing and Better Managing Waiting Times in BC, [BCMA, June 2006] on one of the most comprehensive, well-researched reviews of the waiting time problem in this country and around the world. This is a very important report that must not sit on a shelf.

The report calls for an increase in capacity in the acute care sector—something that is certainly needed. However, it also states quite rightly that “Wait lists are not managed optimally in BC.” This is something we all need to learn before we allocate resources that might be better used elsewhere.

As the report states, accurate data are fundamental to managing wait lists. Through the Provincial Surgical Services Project (PSSP) and with the cooperation of the BCMA and the health authorities, the province is well on its way to establishing the Surgical Patient Registry (SPR). For the first time, this will mean that we will have accurate data that are comparable within and between health authorities.

In tandem with the SPR, prioritization tools are strongly recommended by the report as a management tool. Essentially, these tools will be used to actively manage wait times, to ensure that more-urgent patients are treated within an acceptable time frame, while also ensuring that less-urgent patients are not forgotten. They will also be used to analyze patient flow and reveal bottlenecks in the system so that resources can be allocated objectively. As such, they become very powerful, especially for our profession when we argue for resources.

Most of the recommendations in the report are appropriate. However, recommendation number 3 that “the BC Government and Health Authorities increase operating room capacity by at least 25% within the next two years and implement a strategy to see a further 25% expansion realized by 2009/10” is unrealistic. We have neither the physical space nor the human resources, especially anesthesiologists and nursing staff.

We the medical profession need to push for the implementation of most of the recommendations. We also need to learn more about the management of waiting lists. The Surgical Access Conference that took place in Kelowna in June was organized to share practical experience in reducing waiting times. A report should be produced this autumn. The advent of the SPR, the use of prioritization tools, and the analysis of waiting list data will allow us for the first time to make powerful objective data for the allocation of resources to meet the needs of our patients. We need to run with this.