Wait List Initiatives

Waiting times for surgery are a major concern for Saskatchewan people. The following initiatives will help ensure fair and timely access to high quality surgical services in the Province.

Improve Knowledge and Information

The SSCN oversees the continuing development of the province-wide computerized Surgical Patient Registry. The Registry tracks all patients needing surgery in the province and produces accurate, detailed surgical care access reports for use in managing the system. The public now has access to better wait list information from all Regional Health Authorities (RHAs) providing surgery. Health authorities, physicians and the Ministry use information from the Surgical Patient Registry to match system resources to patient needs and improve access to surgery.

In addition, work is underway to develop and implement a new Surgical Information System (SIS) in six regions. The new automated system will improve the information available for both planning and day-to-day delivery of surgical care. It will enable health regions to make more efficient use of operating rooms and staff and to improve the quality of care for surgery patients.

Better decisions based on better information will ultimately reduce wait times for patients.

Ensure Fairness Among Patients

Physicians use the Patient Assessment Process to consistently and fairly determine a patient’s need for surgery. The process includes standardized sets of factors that surgeons use to assess their patient’s need, and clearly defined “urgency” ranges for specific surgical procedures.

Target Time Frames for Surgery, based on this assessment process, were announced in March 2004.  The targets are performance goals for the surgical care system and are a key initiative in the strategy to better manage access to surgery.

The Province is also undertaking a pilot project on patient recourse for patients who need bypass surgery (Coronary Artery Bypass Graft - CABG). The goal of the pilot project is to develop options to ensure that all patients needing CABG surgery are able to receive it within the pan Canadian benchmark time frames for these procedures. The pilot project is part of an agreement in which Saskatchewan committed to establish a patient wait time guarantee for CABG patients by January 2010 in exchange for $24.8 million in federal funding for wait time initiatives.

Provide Better Public Information

The SSCN web site provides wait time and wait list information from the Surgical Patient Registry for ten health regions that offer surgical services. Improvements continue to be made to the site. The recent addition of new information on wait times for cancer surgery and system performance are examples.

Surgical Care Co-ordinators in Regina Qu’Appelle and Saskatoon Regional Health Authorities provide a means of communication between the regional health authority, patients and their referring physicians. All other regions have also identified surgical contacts.

Increase Surgical Capacity

Health Human Resource Initiatives. Saskatchewan has undertaken a number of initiatives to help ensure we have adequate health professionals.

The Saskatchewan government and Saskatchewan Union of Nurses have signed a partnership agreement that commits to increasing the number of full time equivalent nursing positions by 800. The Province has a number of recruitment and retention programs that provide incentives to health professionals. Regional health authorities have participated in recruitment trips that are bringing Filipino nurses to Saskatchewan. As of March 31, 2009, RHAs employeed more than 100 additional registered nurses and registered practical nurses than they did a year earlier.

The number of nursing education seats was being increased in 2008-09 from 418 to 550 seats and the plan is to increase the number of nursing seats in Saskatchewan to 700 seats. The College of Medicine will increase its annual intake of medical students from 60 to 100 and increase physician residency seats to 120 by 2010-11. In 2008-09, 24 new undergraduate sears and 24 new residency seats were created. The number of training seats for medical laboratory technologists, medical radiation technologists and combined lab and x-ray technicians were also increased in 2008.

The Regina Qu’Appelle Health Region is in the process of planning an Ambulatory Surgery Centre as part of the Increasing Surgical Capacity Project. The planned centre will increase the Region’s capacity to perform ambulatory surgery procedures that do not have to be done in a hospital, and free operating room time in the main hospital operating rooms for more inpatient surgery and complex day surgery procedures. The Province has committed $14 million to the project.

The Saskatoon Health Region is focusing in several areas in order to increase surgical capacity.

The region is currently implementing its service alignment plan, which defines the future roles of the three hospitals in Saskatoon. In this model, Saskatoon City Hospital will focus on day surgery and outpatient or ambulatory services, while St. Paul's Hospital and Royal University Hospital will be the two sites for inpatient acute care. This model will increase efficiency by reducing the duplication of services on multiple sites and not stretching the Region's physician and clinical coverage across sites. The consolidation of services is know to:

	improve the patient care experience,
	decrease the need for transfers between sites,
	increase the volume and efficiency of ambulatory services, and
	improve recruitment and retention of specialized care providers and other staff.

Initial steps in implementing this model have included realigning and consolidating several of the services within surgery to fewer sites. For example, general surgery and orthopedic surgery for patients requiring an inpatient stay are now on two sites, rather than three. Inpatient urology services were consolidated to St. Paul's Hospital in February 2009. Day surgery urology services will continue to be provided at St. Paul's and Saskatoon City Hospital.

Other key initiatives the Saskatoon Health Region is undertaking to increase surgical capacity include: the implementation of the new hip and knee pathway, improving efficiencies within the operating rooms, and improving operating room scheduling processes.

Ensure High Quality Surgical Services

The SSCN has promoted the development of clinical pathways to improve patient service in a number of areas. In each case, a working group composed of key service providers, administrators and others, has been formed to lead the development and implementation process.

A new provincial clinical pathway for hip and knee patients has been developed to improve access, flow and patient satisfaction and enable the treatment of more patients, while maintaining high standards of service. The pathway streamlines the patient’s journey from family physician to post-surgery rehabilitation. It is based on best practices and includes a General Practictioner referral form, intake through a multi-disciplinary clinic, new pre- and post-educational processes, new ward flows and dedicated operating room times and beds. Four Regions (Saskatoon, Regina Qu'Appelle, Five Hills, Prince Albert Parkland) have begun implemenation of the pathway and full implementation will be completed in 2010/2011.

The goal of a new provincial clinical pathway for spine surgery is to reduce practice variations, increase patient access to timely treatment and improve patient care and satisfaction. The pathway is based on best practices and encourages primary care providers to use a standardized system to categorize back pain. The pathway features two treatment options - surgical treatment and medical management. A multi-disciplinary clinic will streamline the patient journey by assessing and triaging patients, coordinating diagnositic imaging and surgical consults, recommending medical management, educating patients and running a pre-surgical program. Implementation of the pathway is expected to begin in two regions, Regina Qu'Appelle and Saskatoon, in 2009/10.

A provincial prostate cancer education pathway is designed to help patients and their families understand the disease and treatment options. Information found at the Ministry of Health website (www.health.gov.sk.ca/prostate-cancer) has been developed by health care professionals to offer the best information on testing, diagnosis and treatment. Men are encouraged to become familiar with the information to supplement one-on-one counselling provided by health providers. A full prostate cancer clinical pathway is being developed to focus on reducing practice variation, improving patient access to timely care and improving patient care and satisfaction.