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 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.

I N D E X

• Definitions
• Calculations
• Data Sources
• Comprehensiveness
• Limitations
• Comparisons
• Data Quality
• Privacy

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 :

NA = Not Available Note : Wait times for prostate and thyroid and endocrine cancers are not available prior to April 2006.

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 did not meet the indicator threshold (i.e. number of reported cases was less than 10 for quarterly data and less than 6 for monthly data).

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.

Data for all service areas is submitted electronically from hospitals and/or clinician offices directly to the Wait Time Information System, with the exception of cardiac procedures.

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.

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 clinicians 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.

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 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 clinicians 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 are 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 :
The intent is to collect the wait for a patient undergoing an operation where cancer is a real possibility. In some cases a negative result is determined only after surgery. Some reported wait time data for cancer surgery includes data for surgeries resulting in benign or non-cancerous tumours.

We are working with the surgical community to ensure that the following reporting options are implemented to more accurately disclose surgical treatment data involving “intentional” and “patient unavailable” wait times.

Option 1 - Subtract the "patient unavailable dates" from the overall wait time.

Option 2 - Enter the decision to treat date as the date when the patient is first recovered from treatment.

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. Please note, as of January 1st, 2008 these cases are excluded from MRI and CT wait time data. For historical comparability, if you would like to view the MRI and CT wait times with these cases please click here.

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.

Several processes and mechanisms have been implemented to ensure data accuracy and its compliance with established reporting guidelines for WTIS data. These include :

• Data Certification Council (DCC) review of the data collection and reporting processes. In addition, the DCC reviews the data to confirm its validity and authenticity to ensure it has not been subject to outside manipulation or revision.
• The establishment of a WTIS focus group under the Access to Care Data Quality Working Group, formed by reps from various key stakeholders including WTIS facilities, LHINs, MOHLTC and CCO staff. This group specifically provides support for CCO-ATC's data quality effort for WTIS.
• A monthly compliance and data quality check process. In addition, a data quality compliance indicator report is also developed and released to all WTIS facilities monthly.
• The creation of a set of data quality standards, a data quality assessment guide, and scorecards to assist hospitals in submitting and reporting good quality data. These documents have already been released to all WTIS facilities.
• An annual DQ assessment is performed using the data quality scorecards, and reports are released to all key stakeholders. Highlight summaries of these reports are also made available on the website.
• An annual Data Quality Validation Program (DQVP) is performed to validate the data entered into the WTIS against the original source data.

Based on the data quality framework provided from the Ministry of Health and Long-Term Care, Cancer Care Ontario’s Corporate Data Quality Improvement Team is the lead for these activities and chairs the Access to Care Data Quality Working Group. For more information related to data quality and the working group, please contact the team via e-mail at CCODataQuality@cancercare.on.ca.

WTIS Data Quality Annual Report Highlights (Fiscal 2008-09) [PDF]

WTIS Data Quality Annual Report Highlights (Fiscal 2007-08) [PDF]

2006-2007 Data Quality Assessment Results

Previous Data Quality Notes

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 or via email at WTIOprivacy@cancercare.on.ca.