Single File: An Equitable Approach to Surgical Wait Times

In March 2020, when the pandemic’s first lockdown was declared in Ontario, many patients received calls telling them their surgeries would be postponed. While keeping people safe and maintaining healthcare was critical, between March 2020 and June 2021, 500,000 fewer surgeries were performed across Canada compared to 2019. (Canadian Institute for Health Information, December 2021)

When Omicron placed more pressure on Canada’s already-strained healthcare system this past winter, the backlog of surgeries continued to grow. This impact is felt by patients – whose conditions and quality of life may have worsened as procedures got pushed back. “Beyond increasing wait times, we are also seeing variation and inequity in terms of how long different patients are waiting for their surgery,” explains Dr. David Urbach, head of the Department of Surgery at Women’s College Hospital (WCH). “People of colour, recent immigrants, non-English or French language speakers often end up with higher wait times and less access.”

To help address this, Dr. Urbach is looking to a queuing system used successfully by restaurants, banks and theme parks for inspiration. The single-entry model centralizes the referral process to connect patients to the next available care provider.

“Under the current model, it typically falls to the family doctor to identify a surgeon for their patients. Ideally, this surgeon would have a short waitlist but there is no way to guarantee this,” says Dr. Urbach. “With the single-entry model, a queue is created for each specific procedure and automatically connects available providers to the next patient based on their acuity and priority in line.”

The concept might seem simple, but it requires a robust system-wide approach to surgical referrals. And while overhauling the current referral system to implement a single-entry model may seem daunting, it’s important to note that it has already been done successfully in some areas. In Canada, the single-entry model has been implemented for cardiac surgery, joint replacement, transplantation, cancer surgery and more.

In response to Ontario Health’s call for centralized waitlist management initiatives, WCH created a brand-new program for anorectal surgery called Toronto Anorectal Program (TARP), which utilizes a single-entry referral model.

At TARP, patients that require benign anorectal surgery are scheduled with the next available expert surgeon who will perform their procedure at WCH, typically within 60 days.  With surgeons from multiple hospitals in the region participating in the program, since it’s inception in March 2021, TARP has seen 510 referrals. “By eliminating bottlenecks and creating a single portal of entry, this program has reduced wait times and enhanced patient care,” Dr. Urbach adds.

The program serves as a model for other single-entry surgical programs for low complexity conditions and provides compelling evidence for the efficiency and equity of centralized referral models in the health system.