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Canadian Journal of Surgery -

Development of pediatric wait time access targets

Development of pediatric wait time access targets

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James G. Wright, MD, MPH*; Kayi Li, BHSc†; Cathy Seguin, RN, MBA‡; Marilyn Booth, RN, BA, MHSc§; Peter Fitzgerald, Hon BA, MA, MD¶; Sarah Jones, MD, Phd**; Kellie K. Leitch, MD, MBA††; Baxter Willis, BA, MD‡‡

*Chief of Surgery, Department of Surgery, Robert B. Salter Chair of Pediatric Surgical Research, The Hospital for Sick Children, †Research Assistant, Division of Orthopaedic Surgery, The Hospital for Sick Children, ‡Vice-president, International Affairs, Hospital for Sick Children, §Executive Director, Provincial Council for Children’s Health, (formerly Ontario Children’s Health Network), Toronto, Ont., ¶Chief of Surgery, McMaster Children’s Hospital, Hamilton, **Chief of Pediatric Surgery, Kingston General Hospital, Kingston, ††Chair and Chief of the Division of Pediatric Surgery, Children’s Hospital of Western Ontario, London, ‡‡Chief of Surgery, Children’s Hospital of Eastern Ontario, Ottawa, Ont.

Abstract

Background: The effective management of wait times is a top priority for Canadians. Attention to date has largely focused on wait times for adult surgery. The purpose of this study was to develop surgical wait time access targets for children.

Methods: Using nominal group techniques, expert panels reached consensus on prioritization levels for 574 diagnoses in 10 surgical disciplines for wait 1 (W1; time from primary care visit to surgical consultation) and wait 2 (W2; time from decision to operate to receipt of surgery).

Results: A 7-stage priority classification reflects the permissible timeframe for children to receive consultation (W1) or surgery (W2). Access targets by priority were linked to 574 diagnoses in 10 pediatric surgical subspecialties.

Conclusion: The pediatric surgical wait time access targets are a standardized, comprehensive and consensus-based model that can be systematically applied to children’s hospitals across Canada. Future research and evaluation on outcomes from this model will evaluate improved access to pediatric surgical care.

Résumé

Contexte : La gestion efficace des temps d’attente constitue une priorité de premier plan pour les Canadiens. Jusqu’à maintenant, l’attention a été concentrée surtout sur les temps d’attente en chirurgie pour les adultes. Cette étude visait à établir des objectifs de temps d’attente pour l’accès à la chirurgie chez les enfants.

Méthodes : En se basant sur des techniques de groupe nominal, des groupes d’experts ont dégagé un consensus sur les priorités à accorder à 574 diagnostics dans 10 disciplines de la chirurgie pour les temps d’attente 1 (T1; temps écoulé entre la consultation en soins primaires et la consultation en chirurgie) et 2 (T2; temps écoulé entre la decision d’opérer et l’intervention chirurgicale).

Résultats : Une classification des priorités en 7 niveaux traduit les délais permissibles pour que les enfants soient vus en consultation (T1) ou subissent une intervention chirurgicale (T2). Les objectifs d’accès selon la priorité ont été reliés à 574 diagnostics dans 10 surspécialités de la chirurgie pédiatrique.

Conclusion : Les objectifs de temps d’attente pour l’accès à la chirurgie pédiatrique constituent un modèle normalisé, complet et consensuel qu’il est possible d’appliquer systématiquement dans les hôpitaux pédiatriques du Canada. Des recherches et des évaluations à venir portant sur les résultats issus de ce modèle permettront d’évaluer l’amélioration de l’accès aux soins en chirurgie pédiatrique.


Accepted for publication Feb. 25, 2010

Competing interests: Research was supported by the Wait Time Innovation Fund and the Ontario Ministry of Health and Long-Term Care. Otherwise, none declared.

Acknowledgement: We acknowledge the hard work and dedication of the Ontario Children’s Health Network (OCHN) and the OCHN Wait Time Task Force, Paediatric Surgery Subcommittee.

Contributors: Drs. Wright, Seguin and Booth designed the study. Drs. Wright, Li, Fitzgerald, Jones, Leitch and Willis acquired the data, which was analyzed by Drs. Wright and Li. Drs. Wright and Li wrote the article. All authors reviewed the article and approved its publication.

DOI: 10.1503/cjs.048409

Correspondence to: Dr. J.G. Wright, The Hospital for Sick Children, Rm. 1254, 555 University Ave., Toronto ON M5G 1X8 james.wright@sickkids.ca