South Shore cataract surgery wait times shortened

After a 24-year career on the South Shore, Dr. Colin Mann found himself in a new and strange position a couple of years ago.

Patients arrived in his office to be approved for cataract surgery, telling him they knew what to expect: neighbours and friends had waited for many months, and they were ready to grit their teeth and do the same.

Cheer up, he told them. 

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The wait list for cataract surgery on the South Shore was dramatically shortened a few years ago without hiring any surgeons or taking operating time away from other types of patients.

It’s one of the province’s success stories, showing that ramping up surgeries is possible and even saves money.

"There's no question at times we have surprised people," Mann said.  "The difference that this makes to patients's lives is enormous."

What happened in South Shore District Health Authority began with crunching numbers. That in itself is fairly uncommon, Auditor General Michael Pickup wrote in his most recent report.

Nova Scotians can track online how long they’ll have to wait for a certain surgery, but hospitals don’t usually do the same thing, he wrote.

"We found the allocation of operating room time does not always consider patient priority and wait lists," he said. "It tends to reflect the historical assignment of time to a surgical service or individual surgeon."

Access to ORs part of problem

At the Dartmouth General Hospital, for example, he found that even for the same procedure, surgeons had wildly different access to operating rooms. In one case, a particular surgeon's patients waited almost a year for surgery while a colleague's patients waited only about two months.

On the South Shore, a manager named Janet Baker noticed that local cataract patients were waiting an unusually long time. She decided that when operating rooms were empty, she would book them for cataract patients.

"We didn't take OR time away from somebody else," she said. "That was time that would have been given up by the surgeon because he was on vacation or if he was away."

That wasn’t enough on its own, though. The two ophthalmological surgeons also had their own days dedicated to cataract operations, with each fitting in six patients per day.

Baker asked them what was stopping them from doing more. She promised the room would open at 8 a.m. and be fully staffed until 4 p.m.

They gave her a very simple answer: there wasn’t enough equipment.

"We can only do so many cases and then those instruments have to be resterilized," Baker said.

The hospital spent about $10,000 on new surgical instruments, and the surgeons increased their productivity by more than 50 per cent, with one managing 10 patients per day and the other doing nine, Baker said.

It’s been easy to keep up that pace, said Mann.

"We're certainly well within what's comfortable and we feel we can do without undue sort of stress," he said.

It also saves money and pain in the long run, since improving seniors’s eyesight is shown to reduce the chances they will fall and get hurt, he said.

Baker said the district has met the national standard of a three-month wait for cataract surgeries, but it also made them cheaper.

"The fewer cases that you do, the more expensive that those cases are," she said.