Move to end years-long waiting lists for surgery

The Health Ministry has acknowledged that patients with very urgent life-threatening conditions are not receiving surgical treatment ahead of less urgent cases.

 Despite a policy of first-come-first- serve, patients may have to wait from weeks to years, said Permanent Secretary in the Health Ministry Hamid O’Brien, as he read a speech for Minister John Rahael. The Ministry is seeking to address this problem and held a workshop yesterday for health officials on “Improving the Waiting List Management System for Elective Surgery in TT” at Ambassador Hotel. The project is being facilitated by the Pan American Health Organisation and Health Canada. “At present, waiting times vary considerably from doctor to doctor and from hospital to hospital, and the length of the patient’s wait is not always commensurate with the severity of their condition,” O’Brien said.

A two-pronged approach is being used to deal with this situation. O’Brien said special projects (cataract, prostate and heart surgery) have been started to bring some relief while the workshop is intended to lead to a more sustainable structured system. O’Brien said the Ministry is pleased to hear surgeons advocating the full use of the public sector’s capacity to do surgeries. “Developing standardised approaches and tools for determining priority of patients to receive surgery is going to be critical to moving forward with this initiative.” The PS said the system developed for the local health sector must be fully integrated with existing approaches to improve the quality of health care and outcomes. On his own behalf, O’Brien asked participants at the workshop to “look seriously” at short-term measures which could be adopted to reduce waiting time.

While the reasons for delays in surgeries may vary, he said many people should be removed from waiting lists because they received treatment elsewhere, “so when someone comes in for surgery you will not have a clerk looking at a list for 100 when it could be 50 people.” O’Brien said improvements in waiting lists will lead to immediate benefits and “we do not have to wait until the other systemic changes are overcome.” Dr Steve Budhooram, Head of Surgery at San Fernando General Hospital, outlined the many factors which affected surgeries at that institution. For 2002, there were 834 ophthamology  patients with a waiting time of 18 months; for ear, nose and throat surgeries the waiting time was 34 months, and general surgery one year. Dr Budhooram said the 2003 list was not available because some surgeons kept the lists. The patient factors impacting on timely surgery are: delinquency (missing appointments), migration, death, co-morbidity conditions such as hypertension and cardiac disease.  “We have a two-tiered system and we would not know who has had their surgeries privately. Many times we would formulate a waiting list and nobody will turn up,” he said.

Lab services also cause surgery cancellation. Dr Budhooram said blood will be sent to the lab and they will report not receiving the specimen or they will have no agents to do tests or the machine is malfunctioning. There are only three Intensive Care Unit beds at SFGH and occasionally the recovery room is used, otherwise surgery cannot be done. Dr Budhooram said one of the biggest problems is staff shortage. “On the ward you have a nursing shortage which means the patient may not be prepared or prepared late for surgery and this in turn affects turnover time.” The operating theatre factors affecting surgery are inadequate staff, insufficient theatre time and malfunctioning equipment. Dr Budhooram said although theatre time is inadequate — 8 am to 2 pm — in reality after noon work output drops, so in fact there are only four hours of surgery. “If we do a cancer of the colon or breast that can take four hours, then hernia and haemorrhoids surgeries are pushed down the list and invariably get put off.” A team from TT visited western Canada to look at their system of managing surgical waiting lists to see how the system could be adapted to TT. John Mc Gurran, director of the Western Canadian Wait List project said the objective of the project is to develop valid, reliable, practical and clinically transparent tools/measures of patients’ priority for waiting list services. In Canada, a point/scoring system is used to prioritise patients. Scores range from zero (less urgent) to 100 (most urgent). Mc Gurran said whatever tool kit is developed, it must be transparent and judged as good by physicians and Regional Health Authorities.