Maximum wait for routine scans doubles


The maximum allowed waiting time for routine medical imaging services has doubled from three weeks to six weeks at King Edward VII Memorial Hospital because of funding changes, The Royal Gazette can reveal.

New imaging services triage guidelines said a move to a $330 million government grant instead of a fee-for-service arrangement had forced an end to weekend overtime in the scanning services unit if the waiting list for routine procedures was over the three-week limit.

But a Bermuda Hospitals Board spokeswoman said waiting times were still “well below” the six-week limit and patients were getting a better value service.

The changes came into force on July 15.

The document that outlined the new rules said: “For the last few years and prior to the cap, we have opened on weekends once we saw a backlog extend close to three weeks.

“These operating hours were achieved by staff overtime funding as they were supplementary to normal shifts.

“We can no longer sustain these expenses with the current cap as all departments across BHB are mandated to reduce overtime.”

The document, dated July 10, expanded the time requirement for routine appointments — the lowest on the urgency scale — to six weeks, and asked for them to be “distributed throughout the community imaging clinics” when possible.

More urgent cases had shorter waiting times under the triage policy.

Emergency scans must be performed inside six hours, high-priority scans within two days and intermediate priority cases must be scheduled for between one and two weeks.

The document said that, at the time of writing, there was a four-week waiting time for routine MRI scans and two weeks for routine CT scans at the hospital.

It added: “Four-week wait times for patients requiring routine examinations is acceptable as most major jurisdictions measure wait times based on volumes in excess of six weeks.

“The objective of the new triage guidelines is to ensure that the KEMH Imaging Services Department reserves appropriate capacity to accommodate the true demand by clinical need.”

Doctors were also asked not to bump patients to a higher priority because it could affect the treatment of patients who were genuine urgent cases.

The document warned: “Diagnostic Imaging will address physicians that abuse the system.”

The BHB spokeswoman added: “The absolute maximum wait for routine appointments is six weeks, but our current wait times are well below this at BHB — and we are doing all we can to maintain and even improve these.

“Alongside the new guidelines circulated in July are a number of initiatives aiming to improve efficiencies within the BHB Imaging Services department with the goal of reducing wait times and costs.

“Diagnostic Imaging utilisation is now at 68 per cent rather than 53 per cent compared to last year. This means the community is getting a better value service that is meeting high quality standards.”

The spokeswoman added: “The grant that BHB now works under requires us to innovate and improve efficiency, but this is only done where international standards of quality — including wait times for services — can be met.

“Overtime is sometimes required, and our plans to ensure it is only used when needed do not necessarily mean reducing service access. Updating schedules can also reduce overtime with more appropriate staffing of services.”

She said that overtime had been used in the past to reduce the waiting time for routine appointments to 48 hours, but that that time frame was not clinically supported as an international standard.

The spokeswoman said that since the start of the new guidelines the average wait times for some imaging services had increased and others had fallen.

The average waiting times for CT scans dropped from 14 days in June to 11 days in October and the wait for ultrasounds plummeted from 29 days to five days over the same period.

But the wait for mammograms rose from one day to 12 days, the wait for MRI scans increased from 14 days to 17 days and the wait for nuclear medicine scans doubled from six days to 12 days.

The average waiting period for radiology, bone density scans and interventional radiology have remained unchanged.

Allan DeSilva of the Bermuda Healthcare Advocacy Group said he had not heard any complaints about delays in scans since the new policy was introduced.

But he said that any delays could affect patients.

Mr DeSilva added: “Most people take these things for granted. You might not think that 13 or 14 days is a long time, but it can be if you are a patient.”

A spokeswoman for the Bermuda Cancer and Health Centre said: “From our perspective, the waiting times for diagnostic imaging used to determine a cancer diagnosis and staging remain minimal and within acceptable standards.

“Overall, the BHB wait times reported seem reasonable as change is being implemented. At this time it is too early to see the long-term impact.”

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Published Nov 28, 2019 at 8:00 am (Updated Nov 28, 2019 at 8:08 am)

Maximum wait for routine scans doubles

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