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Insight into capacity planning for cardiac catheterization services: policy lessons learned from "Looking in the
Mat Mercuri1, Madhu K Natarajan, Douglas H Holder
1Heart Investigation Unit, Hamilton Health Sciences, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada. mercuri@hhsc.ca
Insights
Meeting recommended maximum wait times for cardiac catheterization (CATH) required adding a new lab, highlighting reactive capacity planning. Registry data is crucial for monitoring and future service expansion.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Cardiac catheterization (CATH) is essential for diagnosing and managing coronary artery disease.
- Publicly funded healthcare systems face challenges with increasing CATH demand and limited resources, leading to waitlists.
- Recommended maximum wait times (RMWT) exist for CATH referrals in Ontario, Canada.
Purpose of the Study:
- To evaluate a center's experience in meeting RMWTs for CATH over ten years.
- To discuss capacity planning challenges in delivering timely CATH services.
Main Methods:
- Prospectively collected registry data was used to track patients undergoing CATH.
- Proportion of patients treated within RMWT and waitlist statistics were analyzed annually.
- Factors influencing referrals and capacity were identified, and wait times were compared to RMWTs.
Main Results:
- Despite systematic and capacity enhancements, RMWTs were not met until a fourth laboratory was operational.
- Waitlist data indicated a reactive approach to increasing patient needs.
Conclusions:
- Timely CATH access improvements were reactive, not proactive, to community demand.
- Registry data is valuable for monitoring key indicators like RMWT.
- Informed policy decisions for regional expansion can be supported by this data.
Background:
Cardiac catheterization (CATH) is key in the diagnosis and management of coronary artery disease. Increasing demand coupled with limited resources in a publicly funded system (e.g. Ontario, the largest province in Canada) resulted in a waitlist for this procedure. Our province has recommended maximum wait times (RMWT) for patients referred to CATH. The purpose of this study is to describe our experience over the past decade in attempting to meet RMWTs for patients needing CATH at our centre, and to discuss issues concerning capacity planning in providing timely service.
Methods:
We measured the proportion of patients undergoing a procedure within the RWMT, and calculated both the mean number of patients and mean length of time on the wait list for each year over a decade for those referred to CATH using prospectively collected registry data. We identified factors that increased referrals or improved capacity. Wait time was compared to community standard RMWTs in order to establish if and how RMWTs were achieved.
Results:
Despite a number of systematic and capacity improvements, RMWTs were not achieved until after the addition of a 4th laboratory.
Interpretation:
Improving access to CATH in our centre was reactive to the increasing need of the community rather than based on anticipation of need and continuity of service within RMWTs. Registry data can help monitor key indicators (e.g. RMWT). Prudent use of this information should help policy makers with future expansion in our region.
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