The Nova Scotia Health Authority says its main focus is on improving wait times for knee and hip surgeries — not meeting a national standard.
A report released Wednesday by Auditor General Michael Pickup said the province continues to have the longest wait times for knee and hip surgeries in Canada.
He also said the health authority has fallen short on his two-year-old recommendations on wait-time reporting.
The report says 90 per cent of Nova Scotian patients receive their hip replacement within 750 days and their knee replacements within 800 days — compared to the national average of 182 days.
Tim Guest, NSHA chief nursing officer and vice-president of the integrated health services program, says his key focus is seeing these average wait times shrink.
“My goal would be to see no one wait longer than a year, before I worry about meeting a national standard,” he told the Chronicle Herald Thursday.
“It’s not going to be something we’re going to see happen in the next two, three years. It’s going to take us a bit of time to get out of this issue.”
According to NSHA figures, 2,368 is the base number of hip and knee surgeries expected to be performed each year.
Since 2014, they have been meeting or exceeding this base number. In 2015-16, surgeons in the province performed an additional 675 hip and knee surgeries.
This year, the health authority says they are on track for an additional 879 surgeries in addition to meeting their benchmark number.
“I don’t think there is much chance we won’t hit that,” Guest said.
He said he struggles with, but completely supports, the report’s recommendations on wait times. But he said they are trying to measure their progress by focusing on the volume of surgeries they are able to perform.
“We’ve seen in the last year, for the first time, we were actually able to do enough procedures that the overall (waiting) list didn’t grow,” he said.
There has also been a decrease in the number of patients waiting longer than a year. Since September 2015, he said, they decreased the number of patients waiting for a knee replacement surgery by 10 per cent.
But Pickup’s issue was that the health authority has yet to give people a clear target of how long they have to wait for operations.
What they do provide is an average.
According to Nova Scotia’s health-care “Wait Times” website, a resident in Sydney would need to wait 130 days for knee surgery consultation, and just under a year for the surgery.
But in Halifax, the average wait time for knee surgery is just under three years. And a Dartmouth resident in need of a hip replacement is looking at a wait time of about 852 days, according to provincial data sourced from Oct. 1 to Dec. 31.
Another priority for the health authority is making sure wait lists are accurate.
Guest said there is a priority process, monitored by orthopedic surgeons, where “urgent” cases go first, followed by those who’ve been waiting the longest.
Urgent cases involve patients who are affected the most by the disability or its symptoms.
But if a construction worker requires knee surgery to get back to work, and is waiting in the same line with a retired senior, does one take priority over the other?
“Not necessarily,” Guest said, adding that they don’t prioritize based on age or employment status.
“But if their symptoms related to their knee or hip problem were impacting their ability to function in their everyday life, they may.”
Guest said wait times lengthened because of a range of factors that include a lack of funding in the past that placed a cap on the number of knee and hip surgeries. Another blockage was access to beds, where heart, brain and cancer-related surgeries took precedence over orthopedic procedures. Other contributing factors include Nova Scotia’s aging population and an increase in residents with arthritis. Weather events and breakdowns in technology have also led to some delays.
Instead of dwelling on the past, Guest wants to look at the present and possible prevention strategies for the future.
Now, the province has implemented a “long-waiters” strategy that has provided orthopedic departments with more funding. They also have orthopedic assessment clinics that help surgeons assess individuals to determine if they need surgery.
“As a population, we can have an impact in what the future need is going to be, based on some of our lifestyle choices,” Guest said.
“We might encourage people to be more active and lead a healthy lifestyle so they don’t need to have one of these procedures.”