Healthcare wait-time dashboards in Canada: what CIHI data can and cannot show

What to take away

Two families of CIHI wait-time data

The first family covers scheduled procedures. CIHI states that aggregate wait time data is received from provincial representatives, and its indicator pages name the source as the Provincial Wait Times Registry, noting that data may come from various sources depending on the province. Hip fracture repair is the exception: CIHI calculates it from its Discharge Abstract Database and NACRS in Ontario and Alberta.

The second family covers emergency departments. The indicator for physician initial assessment is built from NACRS, and CIHI's current wait-time page also lists the total time spent in the emergency department for admitted patients.

A dashboard should keep the two families on separate pages. Their sources, coverage and definitions have little in common, and mixing them invites false comparisons. The dashboard framework approach of one question per panel applies directly here.

The metrics you can pull

CIHI's metadata describes the main statistics:

National estimates for the median and 90th percentile are a weighted average of provincial submissions, weighted by provincially submitted surgical volumes. That means the national line is not a simple average of ten provinces, and a dashboard should say so in the panel note.

Benchmarks differ by procedure. The CIHI indicator pages give these examples:

If you are charting a benchmark line, draw it from the indicator page and cite it, not from a number remembered from a news story.

How each wait is defined

The definitions explain what the number can and cannot say.

Ready to be treated. For hip replacement and radiation treatment, the clock starts when the patient was ready to be treated. Radiation treatment ends at the first radiation therapy, and CIHI notes that oncology planning time is included in the wait. Any waiting that happened before the patient was ready sits outside the indicator.

Unavailable time is removed. For the indicators reviewed, patient unavailable time is excluded, along with emergency cases and abandoned procedures. A patient who postpones surgery for personal reasons does not lengthen the reported wait.

Adults only. The cataract, hip and radiation indicators cover patients aged 18 and older, and the CT indicator also covers adults. A dashboard for a paediatric service cannot use them.

Specific procedures. The cataract indicator counts first-eye surgery, and the hip indicator covers planned total hip replacement. A dashboard title such as "surgical wait times" should not claim more than these procedures.

Emergency department. The clock starts at the earlier of triage or registration and stops at physician initial assessment. CIHI reports mostly the 90th percentile and sometimes the 50th. This is the wait to see a physician, not the total time in the department.

Coverage and comparability limits

These are the limits a Canadian dashboard should print beside the chart, because they change how a reader should interpret a provincial ranking.

Put each caveat in a panel footnote rather than a separate page that nobody opens. The reporting practices in reporting mistakes show how correct figures can still lead to a wrong conclusion when the caveat is missing.

What the data cannot show

CIHI's definitions do not cover total time from a first symptom or referral to treatment. The clock starts at the date shown in the table above, so earlier steps are outside the indicator. A dashboard should avoid titles like "how long Canadians wait for a hip replacement" and use wording such as "wait from ready to treat to surgery, as reported by the provinces".

The statistics also say nothing about outcomes, quality or appropriateness of care. A short median wait does not indicate good care, and a long wait does not by itself show a poor hospital. Nor do these indicators measure the length of a waiting list; they describe patients already treated, not those still waiting.

Building the dashboard

A practical structure:

If your dashboard mixes CIHI data with your own organisation's records, check the privacy rules before you combine them. The PIPEDA dashboard compliance metrics article covers the consent and breach records an insurer must track, and health data brings its own provincial rules.

Common questions

Does CIHI publish waits for every province?

Not for every indicator. Hip and knee replacement, cataract surgery and radiation treatment are provided by all provinces according to CIHI, but CT scan waits list seven provinces and emergency department coverage varies.

What does the 90th percentile mean?

CIHI defines it as 1 out of 10 patients waiting this many days or more before receiving care.

Can I compare two provinces directly?

With care. CIHI says some provinces use slightly different methods, so check the Trend tab of its wait times tool before ranking them.

Does a wait-time indicator include time spent waiting to see a specialist?

CIHI's indicator definitions begin at the dates described above, such as the date the patient was ready to be treated or the date the CT order was received. Earlier waiting is outside those indicators.

Official sources