title: How established wait time benchmarks significantly underestimate total wait times for cardiac surgery.
abstract: BACKGROUND
  Wait times for cardiac surgery are well established but may not reflect the total wait time patients experience.
  
  
  METHODS
  The Maritime Heart Center (Halifax, Nova Scotia) cardiac surgery database was used to identify all consecutive patients who underwent elective coronary artery bypass graft surgery between 2002 and 2005 from a single urgency queue. The provincial physician billing database provided a timeline record of dates, physician visits, and diagnoses or procedures performed for each patient. This information was used to assess total and component wait times leading to cardiac surgery.
  
  
  RESULTS
  A total of 705 consecutive patients were included and stratified based on geographical location: urban Halifax Regional Municipality (HRM; n=222), urban non-HRM (n=220) and rural (n=263). Patients from all regions did not differ in age, sex, comorbidities or ventricular function. Using a traditional definition of wait time (time listed), patients waited a median of 56 days (interquartile range [IQR] 38 to 77 days). In comparison, the total wait times based on the time from presentation to surgery were a median of 109 days (IQR 56 to 184 days) for HRM, a median of 121 days (IQR 77 to 184 days) for urban non-HRM and a median of 123 days (IQR 79 to 169 days) for rural patients (P-value nonsignificant). Two modes of presentation emerged that were not influenced by a patient's geographical location. Patients who presented to the emergency department (n=229) waited a median of 73 days. This was significantly less than patients who presented to their family physician (n=476), who waited a median of 135 days (P<0.001). The difference in overall wait for patients presenting to the emergency room was a result of a shorter wait time for referral to a specialist and from seeing a specialist to catheterization.
  
  
  CONCLUSIONS
  The present pilot study demonstrated that total patient wait times for cardiac care and surgery in Nova Scotia are significantly longer (more than twofold) than traditionally reported wait times for surgery alone.
authors.affiliation: Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada. jean.legare@cdha.nshealth.ca
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Legare
authors.forename: D
authors.initials: D
authors.lastname: Li
authors.forename: K J
authors.initials: KJ
authors.lastname: Buth
mesh_terms: D019985:Benchmarking; D001026:Coronary Artery Bypass; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009674:Nova Scotia; D009819:Office Visits / Q000706:statistics & numerical data; D010821:Physicians, Family; D010865:Pilot Projects; D012017:Referral and Consultation; D012189:Retrospective Studies; D012424:Rural Population; D014505:Urban Population; D014850:Waiting Lists