A wait list is how doctors and hospitals keep track of people who need specialized medical care, such as heart surgery, MRIs, and hip and knee replacements. A wait list allows doctors to prioritize their patients by the urgency of the treatment they need. There is no single wait list for all Ontario residents scheduled for surgery.

A wait time is how long you must wait for a specific procedure. You may experience several separate wait times from when you first notice a health problem until your treatment is completed. In Ontario, as in other jurisdictions, we measures the time you wait from when the procedure is formally booked in the hospital, until it is actually carried out. (See the Wait Times Clock below)

Wait times are only a symptom of problems in managing how patients get access to health care. Wait times grow when there are more patients needing health services than the system can treat. Increasing demand may come from a variety of sources such as an aging population that relies more on health care, or from advancements that allow doctors to diagnose more illnesses.

Wait times depend on the type of procedure and the circumstances of the individual patient. Ontario developed wait times targets from direct consultation with leading clinical experts from across the province, who made recommendations based on the best available evidence. These targets serve as goals and tell you how the health system is performing. More information on wait times targets is available here.

A patient needing emergency surgery is treated as quickly as possible and does not go on a wait list. Anyone needing surgery or treatment that is not an emergency will be placed on a wait list.

The length of time a patient waits can be influenced by a number of factors such as the urgency of your illness, the caseload of your surgeon, and the management of patient access by your hospital. Patients with illnesses that are not considered life threatening may wait longer because a hospital's operating room time is prioritized for more serious cases. Click on Wait Times in Your Area on the left side of this web page to find the latest reported wait times for specific hospitals in your area.

The data shows that the majority of cardiac procedures and cancer surgeries take place within days or weeks, while it usually takes months for elective surgeries such as for cataracts or hip and knee replacements. Below are two different graphs showing how long cataract patients wait for their surgery. Using 2003-04 data from the Institute for Clinical Evaluative Sciences, the pie graphs show the progression of patients receiving cataract surgery in Ontario. More than half of all patients had their surgery after waiting about 16 weeks, and 89 per cent were treated in less than a year, with 11 per cent still awaiting surgery. The histograms, using recent wait times data, show that half the patients were treated in about 13 weeks, while nearly all (90%) were treated within 45 weeks.

Source: Institute for Clinical Evaluative Sciences (ICES) Research Atlas Access to Health Services in Ontario

Wait times are influenced by a variety of factors such as :

• The urgency of your illness - patients with illnesses that are not considered life threatening may wait longer because a hospital's operating room time is prioritized for more serious cases.
• The caseload of your surgeon - some specialists have shorter wait times than others.
• The resources available to your hospital - Changes in the capacity of particular hospitals or regions to carry out the procedure.
• Increasing demand for health services in your community and region.

Depending on your situation, you may be able to be referred to another specialist with a shorter wait list, or to another hospital where you might be treated sooner. It is important that you discuss all your options with your doctor before taking any action. It may also help to be prepared for surgery on short notice, in case an earlier opening becomes available.

If your condition changes while waiting, it is important to discuss these changes with your doctor. It is your doctor who will need to assess the severity of your illness and the potential harm to you if treatment is delayed.

The change in wait times at a hospital may reflect the complexity of the problem of wait times. Wait times can be influenced by a number of unique factors at your hospital, such as human resources, demand for health services, operating room time etc. , and as these factors change, the wait times may go up and down. Trends are best interpreted over a longer period of time than one or two months. Over the long term, it is expected that the initiatives underway through the Wait Times Strategy will lead to an overall general reduction of wait times in the province.

The data currently being collected is very basic and does not allow for the type of detailed analysis needed 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 physicians and hospitals can better manage their wait lists. The new system will also allow wait times to be compared to the provincial wait time targets, which are broken down into four priority classifications. By December 2006, this new 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.

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

Increased funding by itself will likely not reduce wait times. While it will take more investment in health care, it also takes a better use of those resources. A number of initiatives are underway to make it easier and faster for patients to get access to health services. The Ministry of Health and Long-Term Care is funding an increase in the volume of procedures, while also supporting education and training of health care professionals to be more effective and efficient. Technology is being improved and upgraded so more patients can be treated in less time. Expert panels are also developing standards for procedures and surgeries to make sure patients are treated in a consistent way.

All surgeons must meet standards of training and ability, both when they are licensed by the College of Physicians and Surgeons of Ontario and when they are granted privileges at a hospital. There is no generally accepted way to tell whether one doctor is better than another.

There are a number of factors that will effect a surgeon's wait times. Some surgeons may have longer wait times because they get more referrals from family doctors, or they have less operating room time, or they take longer to perform a particular procedure. The complexity of a surgeon's cases may also affect his or her wait times.

Any patient who enters the health care system has his or her illness assessed early on to see how quickly they need treatment. Currently, there is not a consistent method for doctors or hospitals to prioritize their patients, nor is there much coordination to make sure that patients who need care the most get the fastest treatment.

Ontario is developing a consistent method for prioritizing patients and this will be incorporated into the Wait Times Information System. Hospitals will be responsible for managing access to care based on this method. Eventually, this integration of care will be extended across a region when it is handled by the Local Health Integration Networks.

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