Surgical assessment: measuring unobserved health

Background: The federal and provincial governments in Canada have invested an enormous amount of resources to measure, report and reduce surgical wait times. Yet these measures under-report the wait period that patients' actually experience, because they do not capture the length of time a patient spends waiting to see the surgeon for a surgical assessment. This unmeasured time is referred to as the "wait one" (W1). Little is known about W1 and the effects that this has on patients' health. Similarly, it is not understood whether patients waiting for surgical assessment actually want or need surgery. Existing administrative and clinical dataset do not capture information on health and decision-making while the patient is waiting for care form a specialist. The objective of this proposed study is to understand the impact that W1 for elective surgeries has on the health of patients and to determine whether this time can be reduced. Methods/Design: A prospective survey design will be used to measure the health of patients waiting for surgical assessment. Working with the support of the surgical specialities in Vancouver Coastal Health, we will survey patients immediately after being referred for surgical assessment, and every four months thereafter, until they are seen by the surgeon. Validated survey instruments will be used, including: generic and condition-specific health status questionnaires, pain and depression assessments. Other factors that will be measured include: patients' knowledge about their condition, and their desired autonomy in the decision making process. We have piloted data collection in one surgical specialty in order to demonstrate feasibility. Discussion: The results from this study will be used to quantify changes in patients' health while they wait for surgical assessment. Based on this, policy-and decision-makers could design care interventions during W1, aimed at mitigating any negative health consequences associated with waiting. The results from this study will also be used to better understand whether there are factors that predict patients' desire to proceed to surgery. These could be used to guide future research into experimenting with interventions to minimize inappropriate referrals and where they are best targeted.