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About Sickkids
About SickKids

September 25, 2012

Surgical wait times decline as Quality Improvement Plan raises the bar

By Christine Macdonald

Wait times for surgery are improving at SickKids. As part of SickKids’ Quality Improvement Plan, the hospital is implementing innovative strategies to ensure that the percentage of “out-of-window” (see sidebar) surgical wait times is consistently declining. This commitment to lead in world-class quality and service excellence is paying off – there have been significant improvements in surgical wait times, with a greater than 40 per cent improvement at SickKids since 2009.

“The Paediatric Access Targets for Surgery (PCATS), developed with the involvement of more than 200 physicians from across Canada, allows a child anywhere at one of the nation’s childrens’ hospitals to receive the same priority for surgery,” says Dr. James Wright, Chief of Peri-operative Services and Surgeon-in-Chief. “Not meeting access targets for surgery has real and meaningful effects on the outcome of treatment for children. Our goal is to ensure that all children receive their surgery within target.”

SickKids remains committed to improving surgical access and has recently tightened its target from 30 per cent to 15 per cent. For the 2011-2012 fiscal year, 18 per cent of surgeries were out of window at SickKids.

“Executive sets a target each year based on the previous year and various initiatives,” says Alexander Mosoiu, Site Lead, Surgical Wait Times. “Every year is better than the year before. We’re doing better, serving patients and families better.”

Next, Mosoiu and his team will look at process redesign and audit and feedback systems. By blocking times for unexpected high-urgency cases, less urgent or other elective surgeries will not be adversely affected. These next steps require careful analysis of demand, surgical access targets, historical utilization and other systemic issues to ensure that operating room resources are maximized.

“Quality improvement in the area of surgical wait times is critical because it impacts health outcomes,” says Mosoiu. “Ensuring that surgeries are in window improves health outcomes in terms of both physical and psychosocial outcomes. There is stress involved with waiting that affects entire families— the sooner treatment occurs, the sooner that stress is relieved and kids may be able to participate more fully in regular development, things as obvious as hanging out with friends and going to gym class.”

The ultimate goal is to have so few out-of-window surgeries that the few that exist can be explained by surgeons because they are familiar with individual cases and their special circumstances. Some surgical services, such as dentistry and cardiovascular surgery, have zero cases out of window in a given month – the aim is to be as close to that as possible for all surgical services.

Surgical wait time is the duration between the date on which a patient, his or her family and the surgeon agree on surgery as a treatment and the date on which the surgery occurs. A diagnosis-based prioritization scheme, PCATS, is used to determine when surgery needs to be done. If surgery is completed in the allotted timeframe, the case is considered “in window.” If surgery is completed after the allotted timeframe, the case is considered “out of window.”