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The Brandon Sun: U.S. option cuts surgical wait list

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This article was written by Karen McKinley for The Brandon Sun. 
Posted: 10:33 PM CST Wednesday, Jan. 19, 2022

Click here to access the original article

“The province is planning to send roughly 300 people to the United States for operations as a way to deal with the growing surgical and diagnostic backlogs. 

On Wednesday, Health Minister Audrey Gordon, along with several members of the diagnostic and surgical recovery task force, outlined four measures the province will take to address the backlog. There are more than 153,000 pending surgical and diagnostic cases, according to numbers last updated Jan. 13 by Doctors Manitoba. 

Part of that is a medical out-of-province referrals program. Gordon said the province is finalizing an agreement with Sanford Health in Fargo, N.D., for some spinal surgeries. No surgeries are scheduled, but Gordon said this will be an interim measure when the situation between Manitoba and North Dakota is safe and Sanford is in a position to perform surgeries safely. 

“This is an option for people who are suffering, waiting for relief, waiting for a return to their normal lives,” she said. “They can speak with their doctor about a referral and they can choose if they want to go to Sanford.” 

The talks are ongoing, but she said they have helped develop a framework to manage COVID-19 risks in Sanford’s operating rooms and in Manitoba. Referrals will be ongoing and surgery performed only when Sanford has the capacity to do so. 

This option is for people who are considered stable, but in pain and need relief, explained Dr. Ed Buchel, provincial surgery lead for Shared Health. He stressed no one needing critical care will be sent to Sanford. 

“This is a program for those we consider in the middle and they are the group that has been waiting the longest,” he said. “This is a great opportunity to deliver care to patients who need surgery.” 

Time in hospital will be anywhere from a few days to a week, he said. After that, the patient and doctors in Manitoba and Fargo will collaborate to determine rehabilitation plans and they will return to Manitoba for their ongoing care. Costs for the surgery will be covered by the province. 

Transferring patients between Canada and the United States has been going on for decades. Ian Shaw, lead for the provincial health system transformation, said this process has been in place for 40 years and has been used to manage patients in other jurisdictions across Canada and the U.S. In Manitoba’s case, when patients are identified for those services by their referred specialist, Manitoba has negotiated this relationship on an individual basis. 

“Earlier in the year, this was identified by surgeons to work through and we have been working with them to develop a structure and a process to manage patients, co-ordinate their care, have their pre- and post-care delivered,” he said. 

He added this program is flexible and allows doctors in Manitoba and North Dakota to manage patients together. They are in the final stages of development and taking steps with Sanford to identify patients to refer to specialists. An update will be provided in the near future. 

While this is an interim program, Buchel said there is a plan to improve health care in the short- and long-term future. However, the system is complex and many departments rely on each other for resources. Speaking to surgery, it needs space, infrastructure and staff as well as surgeons, anesthetists, nurses and systems. 

Human resources is a major component of this, as staff are redeployed to help fill vacancies caused by a myriad of issues, including sickness and burnout. Nurses and licensed practical nurses are being hired to augment the system. In terms of human resources, Buchel said they are looking at different staffing models. They are also actively recruiting surgeons. 

As well, they are in ongoing talks as to how to increase and improve physical spaces for operating and recovery rooms in the province’s care facilities. 

“These don’t take a day, but we are announcing them now because we are talking about them and there are more to come,” he said. 

Another key component is having an accurate surgical wait list management system to track wait times, and the resources they have and the care they need to deliver. That has been approved and is going through the request for proposal system and being evaluated by care providers who deal with those information systems. They hope to implement this as early as this spring or summer. 

“That is a significant portion of our plan to move forward and make sure nobody falls through the cracks. We are looking at staff, space and resources while we simultaneously help people on the wait list.” 

Gordon added there have been many talks behind the scenes over longer-term plans to improve the province’s health-care system. Some of those include certifying internationally trained nurses. The government has committed funding to make sure they get trained and acquire certification and they will continue to work with the Manitoba College of Nurses and the College of Licensed Practical Nurses of Manitoba to get them into the health-care system. 

They are also working closely with Shared Health and doctors in the province to help identify what needs to be done to alleviate long-term problems like staffing. This isn’t a unique problem to Manitoba, so they are studying what other jurisdictions are doing to relieve similar problems in their own systems. 

“We are looking across the entire system to make sure we have the right supports right here in Manitoba to make sure people have the care they need,” she said. 

Gordon said the province is also working on an agreement with Maples Surgical Centre and several other local partners to address issues in women’s health, specifically 3,000 women currently waiting for gynecological procedures. 

Dr. Peter MacDonald, the chair of the task force’s steering committee, said some of the women have been waiting since 2019, and about two-thirds of the cases are eligible for day surgery. He said the task force expects this agreement could accommodate up to 1,000 cases. 

The province is also shifting how it screens for colon cancer to a diagnostic process called fecal immunochemical testing (FIT). MacDonald said FIT screening does not require an endoscopy, and as a result, it will allow for faster screening and will free up more operating room space for other procedures. 

“This is a minimally invasive, highly accurate test — much more accurate and specific than the occult fecal blood test,” MacDonald said. “This will lessen the backlog for endoscopies, specifically colonoscopies, by up to 10 to 15 per cent.” 

He said other initiatives are being explored in the endoscopy area and will be announced in the future. 

The province is also planning to hire and train up to 13 new anesthesia clinical assistants over the next three years and place them in operating rooms across the province. MacDonald said anesthesia services are fundamental to safe and effective surgical procedures, adding anesthesia clinical assistants let anesthesiologists delegate and observe care over multiple patients.”

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