Improve operating room performance and acute care capacity, part IX
This is the ninth part of a series examining the policy barriers and solutions to reducing surgical wait times in Canada. The series has been adapted from a research paper by Andrew Longhurst. The complete paper with reference list for the footnotes is available here.
Streamlining public capacity and operating room performance can also lead to significant wait time reductions and cost efficiencies. Specific strategies include optimizing scheduling and reducing downtime. For example, if two operating rooms (ORs) are used with a staggered schedule, surgical teams can “swing” between rooms as their patients are prepared for surgery by other team members. Efforts to maximize OR time may also include moving less complex procedures out of hospital ORs into specialized outpatient procedure rooms, scheduling more complex cases at the end of the day (which reduces delays and cancellations), and investing in more equipment so surgeons don’t lose time waiting for equipment to be cleaned. Standardizing surgical procedures, equipment, and clinical practices can reduce variation and increase productivity with a relatively small investment of money. Additional capacity can be created by extending OR hours.
The international research shows that increasing public sector capacity, rather than outsourcing, has the greatest potential to reduce waits in the long run.[1] Furthermore, increasing public sector hospital capacity over the long term can effectively reduce wait times. An OECD study of 13 high-income countries found that a greater number of acute care beds is associated with shorter wait times,[2] and a review of 103 academic articles and policy papers concluded that “cross-national comparisons suggest a consistent link between greater capacity (e.g., acute care beds, physicians, overall spending) and shorter wait times and that “[p]roactive, targeted investment in public-sector capacity is an effective long-term strategy to control wait times.”[3] In response to the surgical backlog, most provinces have focused nearly exclusively on increasing the volumes either through extending public OR hours, outsourcing or both.
Increase access to seniors’ home and community care
Better access to high-quality, universal home and community care for seniors will reduce hospital bed shortages, cancellations of scheduled surgeries and, ultimately, surgical wait times for all patients.[4] Home and community care includes home support (e.g., personal care services, and help with housekeeping, cooking, and taking medications), home nursing, rehabilitation therapy, long-term care and palliative care.
Many patients occupying hospital inpatient beds cannot be discharged due to the lack of community-based alternatives. They are referred to as “alternate level of care” (ALC) patients, and the majority are seniors.[5] As our population ages, more people will require home care, long-term, and palliative care.[6] A 2012 report from the Canadian Institute for Health Information suggests that people with complex needs, who lack personal supports, and those with symptoms of dementia, including behaviour challenges, are more likely than others to be in acute care prior to admission to long-term care.[7]
According to the Wait Time Alliance (an organization representing 18 medical-specialty associations), “the ALC issue represents the single biggest challenge to improving wait times across the health care system.”[8] The Alliance emphasized the urgency of improving access to seniors’ care in order to reduce the high rates of ALC patients: “If we can improve how we care for our seniors,” the Wait Time Alliance stated, “we will go a long way toward creating a high-performing health care system, thereby benefiting all patients.”[9] Investing significantly in seniors’ care, can reduce hospital crowding and wait times.
[1] Kreindler, 2010, p. 12; Rachlis, 2005.
[2] Borowitiz et al., 2013, 27.
[3] Kreindler, 2010, 14.
[4] Wait Time Alliance, 2015, 2.
[5] In Canada, the median age of ALC patients is 80 years old (CIHI, 2009, p. 6).
[6] Home care is a broad term that includes professional home nursing and allied health services (e.g., physiotherapy) and home support provided by an unregulated home support or personal support worker.
[7] Canadian Institute for Health Information, 2012.
[8] Wait Time Alliance, 2015, p. 2.
[9] Ibid., p. 7.
