How do I update the estimated wait time for multiple referrals at once?

If a referral appointment cannot be scheduled right away, you can communicate an estimated wait time to the patient and referring provider by selecting it from the 'Anticipated Time to Appointment' drop down menu in the Scheduling pane of the referral.

Updating in Bulk

To update the 'Anticipated Time to Appointment' field for multiple referrals at the same time, follow the steps below:

Note: When bulk updating wait times, wait time email notifications will not be sent to referrers or patients.

  • In the Ocean Portal, navigate to the eReferrals & eConsults area.
  • Within the 'Actions' menu in the bottom left corner, press 'Update Wait Times'.
  • Enter your desired criteria that will be used to find and update matching unbooked referrals.
  • Press 'Update Wait Times'.

  • A confirmation message will appear indicating how many estimated wait times were updated.

How can I improve the accuracy of my calculated wait times?

Ocean automatically calculates the wait times for each of your Health Services Offerings on a nightly basis. A minimum of 6 referrals with an assigned Health Service Offering and a scheduled appointment date are required for Ocean to begin calculating your wait times.

To ensure that your calculated wait times are as accurate as possible as a referral recipient, it is important to account for periods of unavailability for patient reasons (e.g., patient vacations, missed appointments). The information below explains how to entirely exclude specific referrals from wait time calculations, and how to exclude specific date ranges within a referral.

For detailed information on wait time calculations and the inclusion and exclusion criteria for referrals, please refer to the following article: How are wait times calculated and displayed in Ocean?

How do I know if an appointment is included in wait time calculations?

  • Within the 'Scheduling' area of the referral, a bar graph icon is shown when the scheduled appointment date will be included in wait time calculations.
  • If the bar graph icon is missing, the scheduled appointment date will not be included in wait time calculations.

Excluding a Referral from Wait Time Calculations

You may choose to exclude an entire referral from being used in your wait time calculations for a variety of reasons, such as a patient cancelling or missing the scheduled appointment.

Patient wants to Decline the Referral Process

If the patient would like to decline the referral, the referral recipient can mark the referral as 'Declined' with a specific reason, which automatically prevents it from being used in wait time calculations and ends the referrals lifecycle.

  • Locate and open the eReferral in Ocean.
  • Press the 'Decline' button at the bottom of the referral.
  • Using the 'Reason for Decline' dropdown menu, select 'Patient declined', and press the blue 'Decline' button.
  • The referral will automatically be moved to the 'Declined' status folder.
Patient Misses Scheduled Appointment

Depending on your clinic policy regarding missed appointments, you may choose to completely decline a referral or simply rebook the appointment for a later date. In either scenario, it is important to action the referral appropriately to ensure accurate wait time information.

Option 1: Decline the Referral

If the patient missed a scheduled appointment, you can mark the referral as 'Declined' with a specific reason, which automatically prevents it from being used in wait time calculations and ends the referrals lifecycle.

  • Locate and open the eReferral in Ocean.
  • Press the 'Decline' button at the bottom of the referral.
  • Using the 'Reason for Decline' dropdown menu, select 'Patient did not attend scheduled service/appointment (No-Show)', and press the blue 'Decline' button.
  • The referral will automatically be moved to the 'Declined' status folder.

Option 2: Rebook the Appointment

If the patient missed a scheduled appointment but you wish to rebook it for a later date, simply update the appointment dates within the 'Scheduling' area of the referral, and account for the delay by specifying Dates Affecting Readiness to Consult/Treat (DARC/DART) as described in the second half of this support article.

Additional Referral Exclusion Reasons

A referral can also be entirely excluded from wait time calculations without declining it. This is achieved by adding a note within the referral.

  • Locate and open the eReferral in Ocean.
  • Within the 'Notes' area, press the speech bubble icon, and select a pre-worded note from the list.

    Note: Selecting the any of the following 'Note' options will exclude the referral from wait time calculations:

    • • Several attempts to contact
    •  
    • • Patient offered earlier date
    • • Patient requested later date
    • • Patient is an existing client
    • • Original referral redirected
  • The pre-worded note will populate the text box with a reminder that this note will exclude the referral from wait time calculations.
  • Press the blue 'Save' button at the bottom of the referral to save your note.

Excluding Certain Days from Wait Time Calculations

Patients may delay appointments for various reasons such as being unable to be reached, missing consultations or requests to defer. These delays can be accounted for by specifying Dates Affecting Readiness to Consult/Treat (DARC/DART).

Specifying DARC/DART

Dates specified using the DARC/DART functionality will be excluded from wait time calculations. Additional details on this functionality can be found in this article.

  • Locate and open the eReferral in Ocean.
  • Within the 'Notes' area, press the speech bubble icon, and select 'Add Dates Affecting Readiness to Consult/Treat'.
  • Specify the reason, start and end dates, and press 'OK'.
  • Press the blue 'Save' button at the bottom of the referral.

Managing Calculated and Self-Reported Wait Times

Ocean automatically calculates wait times on a nightly basis for each Health Service Offering in your Directory Listing(s). Ocean uses eligible eReferrals sent over the past six months for the calculations.

Ocean Site Admins can view and manage wait times for their Health Service Offerings within the Ocean Portal. This includes the ability to self-report additional wait time information for each Health Service Offering, and choose between displaying the calculated or self-reported wait time in the Ocean Healthmap search results.

  • After logging in to the Ocean Portal, navigate to the 'Admin Settings' page, and select 'Directory Listings'.
  • Select the relevant Directory Listing using the dropdown menu at the top of the page, locate the 'Service Details' section, and click the 'Manage Wait Time Info' button.
  • In the Wait Time Information management area, use the dropdown menu to select the Health Service Offering from your Directory Listing that you would like to manage wait times for.
  • After selecting a Health Service Offering, respective wait time information will appear in the 'Wait 1' and 'Wait 2' tabs.

Currently Displayed Wait Time in Healthmap Search

This section allows you to view and control the wait time value displayed to users in the Ocean Healthmap search results.

  • You can choose to display either the wait time calculated by Ocean based on your received referrals, or you can choose to display a Self-Reported Wait Time (configured below). Clicking the blue text allows you to toggle between displaying the calculated or Self-Reported wait time.
  • In the image above, we can see that the Health Service Offering has been configured to display the calculated wait time of 16 days. When viewing search results for the 'General Surgery' health service on the Ocean Healthmap, the value of 16 days is displayed accordingly.

Self-Report Your Wait Time

  • This section allows you to optionally specify a Self-Reported wait time to accompany your calculated wait time using the dropdown menu. Self-Reported wait times should be kept current and reviewed regularly.
  • When a Self-Reported wait time is specified, the 'Currently Displayed Wait Time in Healthmap Search' toggle is automatically adjusted to display the Self-Reported value.
  • In the image above, we can see that the Health Service Offering has been configured to display the Self-Reported wait time of 4 days. When viewing search results for the 'General Surgery' health service on the Ocean Healthmap, the value of 4 days is displayed accordingly.
  • Both the Self-Reported and calculated wait times are visible within the Health Service Offering details in your Directory Listing on the Ocean Healthmap.
  • If a Self-Reported Wait Time has not been provided, or the calculated wait time sample size is too small, it will appear as 'Unspecified'.

Advanced Notes regarding Self-Reported Wait Times

  • If you configure a Self-Reported wait time to be displayed in the Ocean Healthmap search results (instead of the calculated wait time), please note that this only takes effect for 6 months. After 6 months, the wait time displayed in the Ocean Healthmap search results will automatically revert to the calculated wait time.
  • If you configure your Self-Reported wait time as 'Unknown', Ocean will display a blank wait time in the Ocean Healthmap search results and your calculated wait time will appear as 'Unknown' within the Health Service Offering details in your Directory Listing.
  • You can configure your Self-Reported wait time back to it's default state of 'Unspecified' by selecting the blank option in the dropdown menu.

Public Comments

  • You can optionally include a public comment regarding your wait time information to provide additional context to users on the Ocean Healthmap regarding your wait times.
  • Public comments are visible within the Health Service Offering details in your Directory Listing on the Ocean Healthmap, as well as when your computer's cursor is hovering on the wait time value in the search results.

Calculated Wait Time Statistics

  • This section allows you to view the calculated wait time statistics for your selected Health Service Offering and wait time.

How are eReferral Resubmissions taken into account in analytic data and wait time calculations?

  • If an eReferral is cancelled or declined, it can be resubmitted to the last recipient at any time using the 'Resubmit (Last Recipient)' option within the 'Action' menu.
  • Ocean accounts for referral resubmissions in both analytical data and wait time calculations.

When a cancelled or declined eReferral is resubmitted, both the original eReferral creation date and the latest eReferral sent date are recorded as analytics.

The date of the eReferral resubmission is recorded in the 'referralCreationDate' column of the analytics report, while the date of the original eReferral submission is maintained in the 'referralInitialCreationDate' column.

Ocean calculates wait times using the values in the 'referralCreationDate' and 'scheduledAppointment' columns, which ensures the accuracy of the wait time calculation using the latest iteration of the eReferral submission (i.e., not the date of the initial eReferral creation).

For additional information on wait time calculations, please see: How are wait times calculated and displayed in Ocean?

Resubmissions vs Redirections

Please note that the analytic implications for referral redirections are different than resubmissions.


How are wait times calculated in Ocean?

Introduction

Ocean uses appointment dates and other information stored in its referral database to automatically calculate and display up-to-date wait times within the Ocean Healthmap.

These estimated wait times serve as a useful consideration for referrers when deciding which health service provider is most appropriate for a patient.

For example, the wait times may assist primary care practitioners (PCPs) in finding an orthopaedic surgeon for a patient with a much shorter wait time for knee surgery when compared to the PCPs usual "go to" list of surgeons.

Currently there is no up-to-date, published information on wait times for most health services in Canada, making Ocean's reported wait times a very useful resource for referrers.

Terminology

Wait 1 is an industry-standard term that represents the time from the sending of the referral to the date of the first consultation with the health service provider.

  • Wait 1 may be divided into two smaller wait times, Wait 1a and Wait 1b, which are used when an initial assessment centre is involved prior to seeing the specialist (such as a knee joint assessment clinic).
    • Wait 1a is the time that elapses within Wait 1 between the sending of the referral and the initial screening assessment.
    • Wait 1b is the time that elapses within Wait 1 between the decision to proceed with a specialist consultation and the date of the consultation.

Wait 2 starts after the first consultation, when the decision occurs to proceed with a surgery or other intervention (a decision which happens usually, but not always, on the date of the consultation).

The wait times are sometimes manually adjusted to exclude certain date ranges that would negatively impact a wait time. For example, if a patient heads south for the winter and is unavailable for treatment, the wait time may be adjusted to exclude this time period. These date ranges are called Dates Affecting Readiness to Consult (DARC) and Dates Affecting Readiness to Treat (DART).

How the Calculation Works

The wait times are calculated entirely from the sample of referrals that are stored within Ocean. Some referrals included are true eReferrals, and others are faxed referrals that have been transcribed into Ocean and had their appointment dates manually entered.

Each night, Ocean looks at the collection of eligible referrals sent to every individual health service offering in the system.

Ocean uses these referrals to calculate an average Wait 1 and Wait 2 time for this service offering.

For example, an MRI offered at a particular hospital listing will have its own independent Wait 1 and Wait 2 time calculated, independent from the wait times for a CT offered at the same listing.

In addition, Ocean calculates a standard deviation for Wait 1 and Wait 2, to give stakeholders a sense of the variation in wait times for the service offering.

Referrals that are included in the sample (unless specifically excluded):

For a given health service offering at a listing, referrals are included in the calculation by default when the referrals:

  • Are currently assigned to the specific service offering *
  • Have a specified consultation date (for the Wait 1 calculation)
  • Have a specified surgery or procedure date (for the Wait 2 calculation)

* A special case exists for Rapid Assessment Clinics: Referrals seen at a rapid assessment clinic are included in the rapid assessment clinic's Wait 1a and Wait 1b calculation, even when they have been forwarded on to the specialist listing.

Referrals that are excluded:

  • Referrals sent more than 180 days ago (6 months)
  • Declined referrals
  • Test referrals
  • Referrals that are tagged with a reason-for-wait-time-exclusion by the provider or central intake, e.g.:
    • An earlier appointment was offered but declined by the patient
    • The patient requested or rescheduled to a later date
    • There was repeated difficulty contacting the patient
    • The patient was a pre-existing client
    • The original referral was redirected

Caveats of Wait Time Calculations:

  • The wait time calculations above represent an average based on a (sometimes small) sample of referrals within the system. Consequently, the wait times' accuracy will vary significantly from service to service.
  • The calculated wait time does not guarantee in any way that a patient will be seen within a specific timeframe.
  • Individual wait times may vary depending on the nature of the specific service provided. For example, within a general MRI service offering, an MRI of the foot may have a longer wait time than an MRI of the brain.
  • The wait times may also vary based on the site's triaging. For example, referrals deemed to be urgent will frequently have shorter wait times than routine referrals.

Sample Size Considerations

For each independent wait time calculation, a minimum sample size of 6 referrals is required prior to the presentation of any wait time value. Health service offerings with values less than this value will show "Unavailable" as the calculated wait time.

Sample sizes less than or equal to 10 are flagged with an asterisk to alert users to the potential inaccuracy of the calculation due to sampling errors.

Why are referrals sent more than 180 days ago excluded?

Ocean uses a 180-day running average Wait 1 time, as it is most predictive of what the referral sender's wait time will be. This 180-day snapshot is long enough to provide an adequate sample size, but not so long that it would suffer from stale sample data. Ocean calculates and stores the wait time for all eligible referrals in its analytics, but it also does a separate calculation specifically for the Ocean Healthmap using eligible referrals sent within the past 180 days. It displays the wait time only for this relatively recent subset.

For example, if a clinic has hundreds of referrals received ~2 years ago each with a wait time of 6 months, but the clinic has since become backlogged and every referral received in the past 6 months each has a wait time of 3 years, an 'average of all-time' wait time calculation would result in a misleading ~1 year wait time, rather than the reasonably accurate 3 year wait time.

Conversely, if a clinic previously had a true 3 year wait time for many years, but has recently cleared their backlog and now offers next-day appointment, an 'average of all-time' wait time calculation would provide a long and misleading wait time. It would take many years before this calculation reflects the truly accurate next-day wait time.

Implications For Providers:

Most of the work to calculate wait times is handled automatically by Ocean as part of the routine use of the system. For example, whenever an appointment is entered for a referral (which providers are incentivized to do for other reasons, such as provider and patient appointment notifications), the referral is included in the wait time calculation.

Wait Time Management

Health service providers in Ocean should take the time to appropriately tag ineligible referrals for the exclusion reasons listed above. Otherwise, Ocean will include them in the calculation.

Providers should also enter DARCs and DARTs for referrals (when applicable) to ensure the recorded wait times reflect each referral's true waiting period; otherwise, the wait times will appear worse than they are in reality.

Providers should exclude outliers when appropriate. For example, referrals whose wait times are not determined by queuing, such as timed follow-ups, are usually excluded from the calculation.

For more information please see these articles:

Disputes and Clarifications Regarding Wait Times

If a provider is concerned about referrers or patients receiving misleading information from these calculated wait times, we recommend the following:

  • Review the referrals at the provider's site to ensure outliers are excluded when appropriate.
  • Enter DARCs and DARTs to ensure referrals with artificially prolonged wait times are adjusted appropriately.
  • Set the Health Service Offering's Self-Reported wait time to match the provider's understanding of the correct wait time. This Self-Reported wait time can help inform referrers when the calculated sample may differ from real-world referrals. For more information on managing your calculated and self-reported wait times, please refer to Managing Calculated and Self-Reported Wait Times.
  • Include a Public Comment in the wait time management area for the Health Service Offering. This comment can provide important context, particularly when the service's Self-Reported wait time differs significantly from the calculation, or when specific protocols may influence the referral's wait time.

 

Please Note:

Ocean wait time calculations may differ from other system calculations such as Wait Time Information System (WTIS).


How do I add dates affecting readiness to consult/treat to an eReferral?

Surgical appointments may be delayed due to periods of unavailability for patient reasons. To accurately capture wait times and incorporate these delays, you will want to document the dates affecting readiness to consult and treat.

To remove dates affecting readiness to consult and treat from your wait times, an option has been added to the eReferral Notes function.

  • Click the button next to "New Note" and select "Add Dates Affecting Readiness to Consult/ Treat" from the menu options.
  • Choose the appropriate reason for the delay from the available options.
  • Note: these options are aligned with terminology in the Wait Time Information System.
  • Then, choose the dates that should be subtracted from your wait times for the selected DARC/T reason.
  • Note: If you do not know the end date at the time of logging the DARC/T, you can choose to leave it blank. This will save the DARC/T with an "Indefinite" end value.
  • Click "OK" to save your changes and record the Dates Affecting Readiness to Consult/Treat on your referral.
  • If there are multiple reasons for Dates Affecting Readiness to Consult/ Treat, record each one separately by repeating the steps above.
  • If the DARC/T end date is left as "Indefinite", and you go to add an appointment date on the referral, you will be prompted with the following error.
  • In order to edit the DARC/T, go to the Notes pane of the referral and click on the blue text note that contains the DARC/T information.
  • This will open up the original window that the DARC/T was logged in. Add in the End Date and click OK to save your changes. You will now be able to save the appointment on the referral.

The dates will be subtracted from the appropriate wait (Wait 1 or Wait 2) based on the dates selected in each note and will be added to your referral analytics to allow for reporting in the Wait Time Information System.