The data on this website has been supplied and verified by individual hospitals as part of the funding conditions for extra cases allocated through the province's Wait Times Strategy. The data is submitted electronically from hospitals directly to either the Wait Times Information Office, Cancer Care Ontario or the Cardiac Care Network. The information is compiled by the Wait Times Information Office for reporting on the website. The data is the most current and accurate information available on wait times in Ontario, yet there are significant challenges in compiling and ensuring the precision of this data.

Ontario is in the process of developing a Wait Times Information System (WTIS) that will be more comprehensive, precise and timely. By December 2006, this single information system will be established in approximately 50 Ontario hospitals, representing more than 80 per cent of the total volume for the five health services funded through the Wait Times Strategy. Eventually, this new system could track wait times for all surgical procedures in Ontario.

For surgical procedures, Ontario measures the wait time from when a patient and surgeon decide to proceed with surgery, until when the actual procedure is completed. For diagnostic scans (MRI and CT), Ontario measures the wait time from when a diagnostic scan is ordered, until when the actual exam is completed. This interval is typically referred to as from "decision to treat" to "treatment".

There are several situations that may result in no information being available for a given period of time (e.g., August-September). These reasons are identified in the wait time data tables with the following abbreviations :

NC = Non-compliant This means that a hospital was required to report wait times data for this service, but did not report by the deadline for publication on this website. Note that hospitals that did not submit any cancer data as required are listed as non-compliant only in the Cancer Surgery summary table.

NV = No, or low, volume This means that a hospital, which is required to report, either reported that they did not perform this service during the period, or the number of cases reported was less than 5. Exception: The information for the Religious Hospitaliers of the Hotel-Dieu in Kingston is reported in combination with the information for the Kingston General Hospital.

NR = Not required to report This means that the hospital provides this service, but was not one of the hospitals that received additional funding to provide additional treatments this year, and therefore is not currently required to submit wait times information. There are some hospitals that are not required to report their information, but have chosen to do so.

NS = No service information available This means that no hospitals in a particular LHIN offered this service during the period.

For wait times that are reported for the specific time period, calculations include all cases where the surgery or exam ("treatment") was completed during that time period.

The wait times are calculated by subtracting the "decision to treat" date from the "treatment" date, resulting in a wait time that is measured in days. The wait is calculated for each patient who received treatment within the most current time period, for a particular service area and hospital. From these individual wait times, there are three calculations performed :

Median wait time : The point at which half the patients have had their treatment, and the other half are still waiting. For example, if a median wait time is 26 days, this means that half of the patients waited less than 26 days, and half waited more than 26 days. The median is another way of reflecting what a "typical" patient might have experienced in that time period. Unlike the average, the median will not be influenced by one or two very unusual cases (long or short), and is therefore more stable over time.

Average wait time : The average - or mean - length of time a patient waited to have their treatment. This wait time may be skewed by a few cases which had extremely short or long wait times. The average wait time is calculated by dividing the total number of waiting days that a hospital reported, by the total number of treatments reported during the time period.

90% completed within : The point at which 90% of the patients received their treatment, and the other 10 per cent waited longer. For example, if a 90% wait time is 58 days, this means that 90% or 9 out of 10 of the patients waited less than 58 days, and the other 10% waited more than 58 days.

In some circumstances, there may be a significant difference between the median and average wait time for a specific treatment. This is due to the fact that the average wait time can be dramatically skewed by a few cases that are excessively long. This "skewing" effect becomes amplified if the total number of cases being measured is relatively small. Using the median to measure wait times eliminates this skewing, and better reflects how long the "typical" patient will wait.

The July 2005 data has been removed from the main web site and is archived here because:

• It was the first month wait times data was reported and many of the current data quality checks had not been implemented.
• It is a single month of data, while the subsequent reporting format is for two-month periods.
• Several hospitals did not provide the required data and were identified as "non-compliant". This issue has since been corrected and compliance has reached100 per cent.

Currently, data is submitted electronically from hospitals directly to the organizations identified below. This information is then compiled by the Wait Times Information Office for reporting on the website. This is an interim data reporting process in place until a more robust Provincial Wait Times Information System is implemented (in progress - reporting will begin from this system for some hospitals starting in March 2006).

Data for all service areas except for Cardiac and Cancer is submitted electronically from hospitals directly to the Wait Times Information Office.

Hospitals gather the "decision to treat" information from physicians through a variety of electronic and manual means, and the "treatment" information from their Operating Room or MRI/CT scheduling systems. The hospitals then compile the information and upload it directly into a secure web-based tool at the Wait Times Information Office.

The Ministry of Health and Long-Term Care's Wait Times Strategy has provided funding to hospitals to do additional surgeries and exams. The hospitals that received this funding were selected based on a variety of factors, including a hospital's capacity to perform more cases, and the need for these services in their local area. As a condition of this funding these hospitals were also required to report wait times for these services. There are other hospitals that provide these services, but are not currently required to report their wait times.

Effective April 1, 2006, the following changes have been made to the cancer reporting :

• Thoracic Cancers will no longer include Esophageal Cancers. Esophageal Cancers will now be reported under Gastrointestinal Cancers.
• Genitourinary Cancers will no longer include Prostate Cancers. Prostate Cancers will now be reported separately.
• Head and Neck Cancers will no longer include Thyroid and Endocrine Cancers. These cancers will now be reported separately.

Due to the de-amalgamation of Women's College Hospital from Sunnybrook Health Sciences Centre, effective April 1, 2006, the Ontario Wait Times Website will display the hospital name for Sunnybrook Health Sciences Centre only. Please note that data prior to April 1, 2006 represents data from Sunnybrook and Women's Health Sciences Centre.

Kensington Eye Institute, a not-for-profit independent health facility that began performing cataract surgeries in January 2006, is also required to report its wait times data as of February/March 2006. The Institute was created to ensure patients who have been waiting for a long time for cataract surgery in hospital could get surgery more quickly.

The hospitals currently reporting wait times on this website represent a significant portion of the volume of these services provided in Ontario. The services with higher percentages are typically more centralized into a few specialty centres, allowing for easier capture of wait times. Other services, like cancer surgery are performed in varying numbers in almost all of the hospitals in Ontario, making comprehensive data capture more difficult.

Many procedures used in cancer surgery are the same as procedures for benign (non-cancerous) conditions, and the same physicians perform both cancer surgery and non-cancer surgery. As a result, almost every hospital in Ontario performs at least a few cancer surgeries every year. However, these hospitals with smaller numbers of cancer procedures may not have a formal cancer program or specialize in cancer surgery. Only the 68 hospitals with more than 100 cancer surgeries performed in 2004/05 were identified as providing cancer surgery for this report, but these 68 hospitals account for almost 98% of cancer surgery completed in Ontario.

Emergency cases (a situation where a patient arrives through the Emergency Department of a hospital and/or requires immediate treatment due to an imminently life-threatening condition) are excluded from these wait times, with the exception of Cancer Surgery.

The current data collection process does not allow for an audit trail back to the original source of the data in the physician's office or the hospital scheduling system. As a result, an error in data entry or transcription will have an impact on the wait times reported for a particular hospital. In future, the WTIS will serve as a primary source of information in physician's offices and will pull information directly from existing hospital systems, reducing the need for re-entry of information.

The data elements currently collected are very basic, including the type of procedure and the key dates. This minimum data set does not allow for the type of detailed analysis that is required to identify the underlying causes behind long wait times. The provincial Wait Times Information System (currently being implemented) will contain additional information about the procedure and the reasons for the wait, so that physicians and administrators will be better able to understand these causes and implement solutions to improve patients' access to care. It will also allow the wait times to be compared to the provincial wait time targets, which are broken down into four priority classifications.

Comparison of Current Wait Times Reporting and the Wait Times Information System
Features		Current Wait Times Reporting	WTIS (Dec.'06)
Data Collection	Collect wait times for completed cases
	Collect wait times for cases still waiting
	Near real-time
	Web-based entry from surgeon's office
Public Reporting	By Hospital
	By Local Health Integration Network
	By Province
	By Priority Level
Tools to manage wait lists (for clinicians, surgeons, hospital and LHIN admin.)	Track delays within treatment
	Flag cases approaching wait time target
	Allow doctor-specific wait list management
	Track number of people waiting and their priority level
Prioritize Cases	Uses consistent assessment tool
Measure Outcomes	Links to other data bases to measure outcomes

The wait times calculated show the differences between hospitals in how long patients wait for services, and how wait times are changing for one hospital over time. It is important to note that a wait time calculation based on a very small number of patients over a very short period of time can be misleading, since a single patient with an unusually long or short wait time will have a very large influence on the results for that month (particularly the average wait time). In this situation, a hospital might have a single month with a very long average wait time while the usual wait times are much shorter, and the experience for most patients will be unchanged. The result is that the smaller the number of cases reported, the more difficult it is to draw conclusions about what should be expected.

This issue will particularly affect hospitals that do not treat many patients (for example a small hospital performing cataract surgery), as well as larger hospitals that perform very specialized surgery (for example, surgery for lung cancer).

The date of treatment is clearly defined and hospitals are able to capture this information with good precision. The date of the decision to treat is more challenging, since its definition is less standardized and open to some interpretation. As the WTIS initiative proceeds, the Ministry will continue to work with hospitals, Cancer Care Ontario, and the Cardiac Care Network to refine these definitions so that hospitals and physicians are able to apply the definitions more precisely

The following table summarizes the definitions used in each of the service areas for which wait times are reported :

Multi-site Facilities :
There a many hospitals in Ontario that provide a service at more than one physical location, due to the merger of multiple smaller hospitals. Depending on the populations served and the services provided, the wait times may vary between hospital sites within the same hospital corporation. Data is collected for each of these sites, but is currently reported at the level of the overall hospital facility.

Differences within Facilities :
Although this data shows the wait times for individual hospitals, there may be a wide variety of wait times within each hospital, depending on the individual surgeons.

Other Factors Affecting Wait Times :
There are many factors that may affect wait times for a surgical procedure or diagnostic exam that are unrelated to the efficiency of a particular hospital, a particular surgeon, or the availability of resources. At this point in time, there is no way to capture all of these potential factors in the information that hospitals are submitting, but the provincial WTIS will capture information about when patients are not available for treatment. Although these factors may have significant impact on the wait time for an individual patient, overall wait times are still a good reflection of the current situation for a typical patient at that hospital.

• Patient Choice – a patient with a non-life-threatening condition may choose to delay treatment for personal or family reasons to a more convenient time.
• Patient Condition – treatment may be delayed until a patient’s condition improves sufficiently that surgery or an exam can be performed.
• Follow-up Care – a patient with an existing condition may be pre-booked for a follow-up treatment or exam a long time in advance.
• Treatment Complexity – specific resources may be required for a patient with special requirements, resulting in a delay until these can be scheduled.

Cancer Surgery :
Unlike the other surgical procedures being tracked through the Wait Times office, procedures for cancer can only be definitively described as "cancer surgery" after the fact, since these procedures may be done to investigate suspected cancer. Cancer Care Ontario (CCO) has been working with hospitals to refine the methodology for identifying procedures that provide definitive cancer treatment, but the wait times reported may include some cases that were later determined not to be cancerous.

A majority of cancer patients receive more than one type of treatment, so that surgery may be preceded by chemotherapy and followed by radiation (for example). The multiple treatments that are received mean that patients may be waiting to recover from the side effects of their first treatment before they are well enough to proceed to surgery. CCO is currently working to clarify these situations so that appropriate wait times can be captured for patients receiving multiple therapies. This information will also be captured in the provincial Wait Times Information System once implemented.

MRI/CT Diagnostic Scans :
A patient with an existing condition may be pre-booked for a follow-up exam or a series of follow-up exams at a later date, resulting in apparently long wait times for those particular exams.

Cardiac :
Cardiac wait time information is collected by the Cardiac Care Network. Additional information about the methods of data collection and the limitations of the data is available at www.ccn.on.ca.

The wait time information shown here only includes patients who are residents of Ontario. If a patient is treated in Ontario, but is a resident of another province, their wait time will not be included. For angiography, 98% of patients treated are residents of Ontario.

For angiography, wait time information is only shown for those patients whose primary indication is coronary artery disease. These patients account for more than 85% of total angiography referrals. If a patient requires angiography for another medical reason, their wait time will not be included.

The wait time information reported on this website is captured and analyzed by different methods than the information reported in the ICES Access to Care report and in the CCO Cancer System Quality Index. These sources of information cannot be directly compared. Reasons why these data sets are not comparable include: different hospitals are included, different procedures (e.g., for cancer) are included, and different numbers of procedures are included.

There is work underway to develop standard definitions for wait times across the country, but caution should be exercised when comparing data between provinces.

Ontario has developed wait time targets for the optimal length of time within which a patient should be treated. These wait time targets were developed with the help of clinical experts and serve as a method of accountability and provide a goal to achieve. These targets include urgency classifications and will be incorporated in the provincial Wait Times Information System currently being implemented. A complete list of Ontario's wait time targets can be found here.

The data published on this website represent all non-emergency patients who received these services, but the wait times are not currently broken down further by urgency or priority of patient need. Physicians assess each patient and determine how urgent their need for treatment is, and as a result the wait times may be very different for a patient who requires surgery but is medically stable and able to wait at home and a patient who is classified as urgent and requires surgery as soon as possible to prevent their condition from worsening.

The Wait Time Information System (WTIS) keeps all personal health information collected secure and confidential. A privacy policy outlining the Wait Time Information Office’s (WTIO) privacy practices and the safeguards Wait Time Information Office staff employ to protect personal health information in the WTIS is available on the Cancer Care Ontario site (click : About CCO > Privacy Policy > Wait Time Information System Privacy Program).

The WTIO has a Privacy Lead who ensures all Wait Time Information Office staff follow the Privacy Policy. The Privacy Lead is also the main public contact for information about the Wait Time Information Office’s privacy practices. You may contact the Privacy Lead at: 505 University Avenue, 17th Floor, Toronto, Ontario, M5G 1X3, 416.971.9800 ext. 3359 or via email at WTIOprivacy@cancercare.on.ca.