Canadian Paediatric Surgical Wait Times (CPSWT) Project

Following the development of the National Paediatric Surgical Wait Times Strategy, all sixteen paediatric academic health sciences centres in Canada, led by the Paediatric Surgical Chiefs of Canada, came together in an unprecedented collaborative initiative: the Canadian Paediatric Surgical Wait Times (CPSWT) Project.

The CPSWT Project is the first collaborative in Canada to develop a standardized methodology to measure, monitor and manage paediatric wait times in all surgical subspecialties, at hospitals across jurisdictions. The database contains mature paediatric surgical wait time statistics for approximately 150,000 cases from September 2007.

The data enables hospitals to benchmark their results thanks to the adoption of standardized access targets (the Paediatric Canadian Access Targets for Surgery, P-CATS). P-CATS were developed by over 100 paediatric surgeons in expert panels and furthermore accepted by the Paediatric Surgical Chiefs of Canada (PSCC).

The CPSWT Project received the 2009 Gold Leadership Award by the Institute of Public Administration of Canada. The project won the award for its outstanding vision, innovation and collaboration, in pursuit of better outcomes for Canadian children and youth.

The project’s high-level results were published in the Wait Time Alliance Report Card on Wait Times in June 2010 and received national media coverage: http://www.waittimealliance.ca/media.htm

Project Goals

• Measure and address surgical wait times for Canada’s children and youth.
• Enable participants to benchmark themselves with their paediatric peers across Canada.
• Provide strategies to reduce wait times and improve operational efficiencies.
• Foster best practice sharing and collaboration on common issues across jurisdictions.

Achievements

Within 2.5 years and with a relatively small investment, the CPSWT Project has had an unparalleled impact on wait times across Canada. Namely, the project has:

• Developed a common methodology to measure, monitor and manage paediatric surgical wait times and implemented it at 24 hospitals located in 8 jurisdictions;
• Generated an unprecedented central database containing data, benchmarks and trends from key paediatric facilities across Canada in all surgical subspecialties;
• Provided actionable management information and strategies for the reduction of wait times for its participating hospitals.

In a relatively short period of time, this project demonstrated unprecedented achievements in the development and successful implementation of a common language to measure and address wait times in Canada. Surgeons and administrators at participating hospitals find this system easy to use, objective, and useful for making clinical and management decisions.

The project is also leading initiatives that leverage and share the expertise of its participants to support the management of wait lists, as follows:

• The development of Clinical Practice Guidelines for the Management of  Cryptorchidism in Children and Youth for both primary and tertiary care providers based on literature review and expert panel opinion, with key recommendations for referral, treatment and follow-up practices.

• An analysis of capacity at participating Paediatric Academic Health Sciences Centres to identify and estimate any gap between capacity and demand for paediatric surgery.

• A compilation of best practices in measuring operating room performance and efficiency based on literature review of best practices and a survey of current practices at participating hospitals.

Impact

At national level, the P-CATS database represents the only source of paediatric wait time information from across Canada currently available in this country. The data, collected since September 2007 from key paediatric facilities, shows that on average, approximately one third of paediatric patients received surgery past their access targets.

At the local level, participating hospitals have used the P-CATS data to reduce the percentage of children not meeting access targets by active management of their wait lists and resources, with notable results. Monthly data analyses and reports have enabled participating hospitals to: 1- prioritize, schedule and manage wait list cases based on acuity; 2- distribute resources based on need; and 3- benchmark themselves with their paediatric peers in Canada.

This is what our participants say:

“Several services in our hospital have been able to use the P-CATS data to improve their processes, resulting in between 89% and 94% of patients receiving surgery within the acceptable wait times”- Surgeon-in-Chief, Academic Paediatric Health Centre

“We used the P-CATS data to request provincial funding for 100 additional procedures in two services” - Surgeon-in-Chief, Academic Paediatric Health Centre

“Standardized, diagnosis-based targets (P-CATS) are a better system for children. It is less prone to manipulation and allows us to make finer prioritization of cases based on acuity”- Site Lead, Academic Paediatric Health Centre

Funding

The CPSWT Project has been funded from March 2007 to March 2010 by Health Canada through contribution agreements under the Health Care Policy Contributions Program. The project is currently seeking funding to continue the collaboration, data collection and benchmarking, in order to support the effective management of wait lists and improve access to care for Canada’s children and youth.

For more information please contact Alexandra Schelck, Project National Site Coordinator, at 416-813-7654, Ext. 28533.