A person wears a face mask as they walk past the emergency department of the Vancouver General Hospital on November 18, 2020. B.C. will conduct an independent review of the government's operational response to the COVID-19 pandemic. THE CANADIAN PRESS/Jonathan HaywardJONATHAN HAYWARD/The Canadian Press
British Columbia’s Ministry of Health says the province’s surgery backlog is now in a better place than it was before the COVID-19 pandemic, but some experts argue the exclusion of unscheduled patients renders the government data incomplete.
In May, 2020, the provincial government laid out a plan to catch up in less than two years on surgeries that were postponed during the first wave of the pandemic and significantly increase the number of surgeries performed above pre-pandemic levels.
Health Minister Adrian Dix says the government has fulfilled that promise.
“We made a major investment on surgery,” Mr. Dix told The Globe and Mail. “That started immediately after the resumption of all the surgeries in May and June of 2020. And making up that ground is really important, and having fewer people waiting for surgery now than before the pandemic is a real achievement for the system.”
As of Feb. 3, the overall surgical wait-list was 86,889 – 7.5 per cent smaller than the wait-list of 93,902 as of March 31, 2020, according to the Ministry of Health.
The data show that 50 per cent of patients during the 2021/22 fiscal year had their surgery one week faster than patients in 2019/20. For urgent surgeries specifically, the 2021/22 median wait time as of Feb. 3 was 5.4 weeks – a 1.5-week reduction from the 2019/20 median wait time.
In terms of non-urgent surgeries, the 2021/22 median wait time was almost a week less than it was pre-pandemic.
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The Health Ministry said that, to achieve this goal, it worked with health authorities to extend operating room hours, expand summer capacity, improve operating room efficiency, implement new initiatives to increase capacity and increase essential personnel through training and recruitment.
Some health professionals and experts said that, while it’s encouraging to know that B.C. has put more money into the system and attempted to clear up the backlogs, the data provided by the ministry does not capture a full picture of the long-standing problem with surgical wait times.
“I think it only tells part of the story, because there is a lot of information out there around wait times that we don’t see,” said Jason Sutherland, a professor at the University of British Columbia who researches the links between funding policy and patient-reported health outcomes, in an interview.
For example there are many surgeons who don’t register their patient for surgery right away, so those patients are waiting but are unscheduled, he added.
“Some of the surgeons don’t want to put patients on the registered list until they’re more confident about when they can get surgery and communicate that back to patients,” he said. “So the consequence is that the province only sees the patients that surgeons want to put on the list.”
Without knowing the number of unobserved cases, Dr. Sutherland said it’s hard to tell whether or not wait times really have decreased.
Radiologists in B.C. also raised questions about how the data was collected and measured, and whether it truly reflects the problems in the system. Charlotte Yong-Hing, president of B.C. Radiological Society, said medical imaging is now experiencing extremely long wait times for all types of procedures.
“There’s likely tens of thousands of patients that require medical imaging that are not currently being scheduled due to the already long wait-list,” she said. Further, the medical imaging backlog extends to delays in diagnosis and treatments, she noted.
“The presentation of wait times is not how waits are typically tracked. And the percentile presentation comes without medical indicators,” she said, adding cancer patients are not included in wait-time data.
The B.C. Radiological Society, as well as other doctors’ groups in the province, have been calling on the government to be more transparent on surgical data.
Katharine Smart, president of Canadian Medical Association, said not all provinces report wait-list data the same, and numbers provided by governments can reflect different things.
“It also depends on how they’re defining their wait-list, and how hospitals book surgery. Some are counting from the time the booking form is filled out, some are counting from the time the surgery is actually booked,” she said.
The Ministry of Health confirmed that it reports on how long a patient waits for surgery after they have met with their specialist. This is calculated from the time the procedure is booked until it is completed or until the medical issue is resolved, and does not include the time a patient waited to see the specialist after being referred by their physician.
The ministry said the method B.C. uses for reporting wait times aligns with other provinces.
Regarding the backlogs for medical imagery, the ministry says it collects information on wait times for medical imaging based on the patient’s priority level – emergency, urgent, semi-urgent, non-urgent and routine follow-up – and not the purpose of the exam.
Dr. Sutherland said it would be beneficial to have an automatic registration when the patient consents so that all of the surgeries would be viewable on the registry, rather than wait for surgeons to register their patients.
He also pointed out that currently there’s no resources available to patients waiting. He suggests the government to provide support, including mental-health services and physical therapies while patients are waiting.
Dr. Smart said it’s important to look at the human resources side to ensure the already exhausting health care workers are not further burned out while catching up on surgeries. In B.C., the province recently added 602 new nursing seats to build the work force.
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