Managing eReferral Wait Times

Ocean automatically calculates wait times on a nightly basis for each health service offering in your listings. Ocean uses eligible eReferrals sent over the past six months for the calculations.

Note: Some eReferrals are excluded from wait times if there are notes entered in the referral that indicate the appointment was delayed by patient availability. If there are any dates affecting readiness to consult and treat entered, those periods will be removed from the wait times as well.

To view the wait times for your directory listing(s), navigate to that listing in the Ocean Portal and complete the steps below.

    • Select the directory listing and health service offer that you would like to view the wait times for.
    • In the offer details, click the wait time next to Wait Time 1 or Wait Time 2 depending on which wait time you would like to view.
    • From this window, you can view Ocean's calculated wait times and the details about how they were calculated.
    • If you would like to specify a different wait time than the one that was calculated automatically, use the drop down menu beside Claimed Wait Time to choose the appropriate option.

Note: You can also view individual wait times using your eReferral Analytics.


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 at any time using the 'Resubmit' option within the 'Action' menu.
  • Ocean accounts for resubmitted eReferrals 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?


How are wait times calculated and displayed 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 health service directory at OceanHealthMap.ca.

The estimated wait times should 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 had their dates manually entered by a central intake site.

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 and a 90% Within wait time 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 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.

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 this article: Managing eReferral Wait Times

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 site's "claimed" wait time within the health service offering's wait time dialog to match the provider's impression of the "true" wait time. This manually-entered wait time can help inform referrers when the calculated sample may differ from real-world referrals.
  • Provide a comment in the health service offering's wait time dialog for the service. This comment can provide important context, particularly when the listing's claimed 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 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.