Health authorities eliminate 'long waiter' list for hip, knee patients

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New Brunswick’s two health authorities say they will eliminate their lists of “long waiter” hip and knee replacement patients this spring.

Amy McCavour, vice-president of clinical services for Horizon Health Network, said in an interview last Friday the authority has a goal of finishing procedures for patients who have been waiting for a year or more by March 31.

“Across Horizon, we have done that,” she said, noting that at the beginning of the initiative, there were about 700 patients on the long-waiter list.

The lists in Fredericton and Miramichi have already been completed, said McCavour.

Saint John has four patients left, and Moncton has three remaining patients, with all the procedures scheduled for this week, she said.

In a press release Wednesday, Horizon said that as of Thursday, March 28, all patients waiting a year or more for a hip or knee replacement surgery have had their procedure completed, or they were offered a surgery.

There were 37 patients who were offered a date but were unavailable for “personal reasons,” McCavour said. Those patients will be rescheduled as soon as possible, depending on operating room availability.

Horizon was able to eliminate the waiting list by adding staff and locum anaesthetists and increasing access to ORs.

“Bringing in extra anaesthetists to run extra rooms was very helpful,” said McCavour.

Miramichi Regional Hospital was able to set up a short-stay unit for patient recovery. In Fredericton, surgical access was increased and hip replacements were added to the surgical services at the Upper River Valley Hospital, in addition to knee replacements that were already being done, said Dr. Patricia Bryden, Horizon’s executive clinical/academic department head and co-leader of surgical services.

“Upper River Valley and their staff were instrumental in helping us get Fredericton done,” said Bryden.

Staff also called patients waiting for surgery, to see if they were still healthy enough to undergo the procedure.

“Many of these patients hadn’t been seen in a long time,” Bryden said.

Next, Horizon is planning to tackle waiting lists for other surgical procedures.

“We’re going to continue to work this, but our hope is not to end up in a similar situation in the future,” Bryden said.

Vitalité Health Network said in a statement it expects to eliminate its list of long waiters by April. 

Central intake system on the way 

McCavour said preparations are underway for a central intake system where all surgical referrals go to one central location. Horizon and Vitalité were both involved in the planning, along with the Department of Health.

The referral system will show patients the average wait times for individual surgeons, as a guide to decide who they want to perform their surgery.

Patients will have the option to choose a surgeon with the shortest wait list in the province, or, if they would like to stay closer to home for their surgery, they can select the surgeon in their health zone with the shortest wait times.

“We want patients to have access to the surgery they need when they need it and have choices,” said Bryden.

It will also help primary-care providers see when surgeons have closed their offices to new referrals, which often adds time to a patient’s wait.

“There’s a lot of back and forth, a lot of wasted time, so this will help with all of that,” said McCavour. “No family care provider actually knows what the surgeon has on their wait list.”

The intake system rollout will begin with hip and knee replacements, and will eventually expand to other procedures. For Horizon, it will be launched zone by zone, rather than all at once.

Bryden and McCavour both said the expectation is for the intake system to be up and running within the year.

When Vitalité was asked about the central referral system rollout, it said “a date is yet to be established, but our teams are working on it.”  

Health Department spokesperson Sean Hatchard said in an email the department will have more information on the centralized surgery referral system in the future.

Wait times not accurate, Horizon says 

McCavour said the surgical wait times listed on the Government of New Brunswick website aren’t accurate, because they only take into account when patients were added to the official list, and doesn’t include the time they waited to see a surgeon to determine if they needed surgery, following a referral from their primary care provider.

“Once you are a referred to a specialist, you can often wait maybe six months to see them,” she said.

New Brunswick has the third longest wait times for surgical procedures in the country, according to a report published by the Fraser Institute.

The total waiting time between referral from a general practitioner and delivery of medically necessary elective treatment by a specialist, averaged across all 12 specialties and 10 provinces surveyed, has risen from 27.4 weeks in 2022 to 27.7 in 2023. 

The report states in New Brunswick, the waiting time from general practitioner referral to completion of the procedure is 52.6 weeks. Nova Scotia and P.E.I. are the only two provinces with longer wait times.

According to the Government of New Brunswick website, five out of 10 orthopaedic surgeries in the province were completed in 166 days, and nine out of 10 were completed in 466 days.

The website states there is no national benchmark for the surgery, and the data for wait times only includes surgeries completed between October and December 2023.

The department and the regional health authorities are focused on improving access to surgery, said Hatchard.

“Reducing the surgical wait time for New Brunswickers waiting more than a year for hip and knee replacement surgery was identified as a key action item in the provincial health plan,” he said, noting that patients waiting for joint replacement surgeries are often in pain, and are unable to be fully active in their daily activities. 

“That is why over 1,600 long-waiting hip and knee replacement surgeries have been completed since September 2022. This is a result of collaboration between the Department of Health and the RHAs.”