Chapter 3 Ministry of Health and Long-Term Care Section 3.08 MRI and CT Scanning Services urgent (within two days), semi-urgent (within 1.0 Summary 10 days) and non-urgent (within 28 days). These targets are set at the 90th percentile, which repre- sents the time within which 90% of patients in each Diagnostic medical imaging includes the use of category should receive their scan from the date of magnetic resonance imaging (MRI) and computed referral for the scan. This means that no more than tomography (CT) scans to provide physicians 10% should wait any longer than that. with important information for diagnosing and Our audit found that, overall, Ontario’s wait monitoring patients’ conditions. Timely, quality, times for patients requiring MRI and CT scans were medically necessary scans can help doctors to the lowest when compared to five provinces where accurately diagnose and treat many diseases earlier the 90th percentile wait-time data was available in their course, positively contributing to patients’ (public information is not available from British health outcomes. Columbia and Quebec). However, many Ontarians Chapter 3 • VFM Section 3.08 As technological advances continue to broaden who needed scans have had significantly long waits the range of their medical uses and the diseases in comparison to Ministry targets. We also found that can be diagnosed, MRI scans performed have that if existing MRI and CT scan machines had been increased by 17% and CT scans by more than 30% operated more hours, more patients could have over the five years up to 2017/18, excluding emer- been scanned, thereby reducing wait times. Our gency cases (as emergency data was not required to audit also identified opportunities where increased be collected before 2015). efficiency and better use of resources could help The Ministry of Health and Long-Term Care to reduce wait times for MRI and CT scans. While (Ministry) is responsible for overseeing, through some of our specific findings are common to both the 14 Local Health Integration Networks (LHINs), MRIs and CTs, others are unique to either MRIs or the funding and performance of MRI and CT CTs, as follows: services in Ontario. Of the 137 public hospitals in Ontario as of April 2018, 78 had at least one MRI or CT machine. MRI Scanning Services Timely access to MRI and CT scanning services is For MRIs, in 2017/18, a total of 108 MRI machines a fundamental part of Ontario’s Wait Time Strategy. in 52 hospitals performed over 835,600 examina- The Ministry has set four priority levels for radiolo- tions. During the same fiscal year, the Ministry gists to use to triage patients and has set a wait-time provided funding of $157 million, plus a one-time target for each level: emergency (within 24 hours), additional payment of $7.3 million, to these 365 366 hospitals, to be used specifically for providing MRI longest wait times, as compared to 63 days in services. Hospitals also have the discretion to use the LHIN with the shortest wait times. funds from their global budgets (annual lump-sum • Patients wait unnecessarily long times funding from the Ministry) or other sources to pro- for MRI scans, while machines are not vide additional MRI services. operating for sufficient hours, despite • 65% of semi-urgent and non-urgent available capacity. We found that MRI patients waited longer than the Ministry’s machines could have been operating more targeted waiting period to receive their hours, thereby reducing wait times, but the MRIs. Ontario hospitals were mostly able hospitals were financially unable to increase to provide timely services to patients who their operating hours for these machines. If required either emergency or urgent MRI all 108 MRI machines in Ontario’s hospitals scans, but were unable to do so for semi- had operated for 16 hours, seven days a week, urgent and non-urgent patients. It is still hospitals would have been able to outperform important for semi-urgent and non-urgent the Ministry’s wait-time targets. patients to receive timely services. Long wait On average, all 108 MRI machines were times delay their diagnosis and treatment, used at only 56% of maximum capacity and can impact their quality of life, such (which is running 24 hours a day, seven as their ability to return to employment, days a week) in 2017/18. We estimated the school or everyday life. In some cases, the additional cost to meet the Ministry targets long wait can result in deterioration of the by the end of 2018/19 would be about patient’s condition. $34 million, assuming hospitals operated For emergency patients, only 5% waited machines 132,197 more hours than they longer than the 24-hour target. For urgent operated them in 2017/18, at a rate of $260 patients, 17% waited longer than the two-day per hour. target (up to five days). Semi-urgent and non- • Patient no-shows (missed appointments) Chapter 3 • VFM Section 3.08 urgent patients accounted for 91% of the total are costly, but the Ministry and hospitals MRI scans in 2017/18. Overall, only 35% (not do not understand why they occur. When the intended 90%) of semi-urgent and non- patients do not show up for an appointment urgent patients received MRI scans within the or cancel it the same day, scanning machines Ministry’s wait-time targets of 10 days and 28 can sit idle if hospitals are unable to fill days, respectively. The remaining 65% (not the time slot quickly. Lack of user-friendly the intended 10%) waited longer than these communication systems at the hospitals to wait-time targets (see Figure 7). allow patients to confirm receipt of their • Wait times for MRI scans vary depending appointment, including emails and text- on where the patient lives in Ontario. The messaging, contributed to patient no-shows. wait-time disparity for non-urgent patients We also noted that none of the four hospitals was the most significant. Depending on where we conducted audit work routinely where a patient lives and the demand for MRI tracks reasons for no-shows. scanning services in that LHIN, patients have MRI patient no-show rates across Ontario a shorter or longer wait than in other LHINs. hospitals ranged between 0.1% and 13.4% The Ministry has not analyzed why wait times of scheduled appointments. In 2017/18, vary significantly among LHINs. hospitals reported a total of 48,320 MRI In 2017/18, 90% of non-urgent patients appointments where patients did not show waited up to 203 days in the LHIN with the up, which we estimated cost hospitals about $6.2 million, mainly to pay for staffing. MRI and CT Scanning Services 367 CT Scanning Services available capacity. We found that CT In 2017/18, a total of 165 CT machines in 78 hos- machines could have been operating more pitals performed almost 1.8 million scans. In the hours, thereby reducing wait times, but the same year, the Ministry gave $9 million to these hospitals were financially unable to increase hospitals to be used specifically for providing CT their operating hours for these machines. services. Hospitals rely more heavily on their global On average, all 165 CT machines were budgets to provide CT services—the $9 million is used at approximately 37% of maximum intended to be supplementary funding. capacity in 2017/18, despite long wait • 33% of semi-urgent and non-urgent times. Cancer Care Ontario does not have a patients waited longer than the Ministry’s predictive model to determine the number of targeted waiting period to receive their hours needed to achieve the Ministry’s wait- CT scans. Ontario hospitals were mostly time targets for CT scans. able to provide timely services to patients • Patient no-shows (missed appointments) who required either emergency or urgent are costly, but the Ministry and hospitals CT scans, but were unable to do so for semi- do not understand why they occur. Lack urgent and non-urgent patients. of user-friendly communication systems at For emergency patients, less than 1% the hospitals to allow patients to confirm waited longer than the 24-hour target. For receipt of their appointment, including emails urgent patients, 4% waited longer than the and text-messaging, contributed to patient two-day target (up to four days). Semi-urgent no-shows. We noted that none of the four and non-urgent patients accounted for 49% of hospitals where we conducted audit work the total CT scans in 2017/18. Only 67% (not routinely tracks reasons for no-shows. the intended 90%) of semi-urgent and non- CT patient no-show rates across Ontario urgent patients received CT scans within the hospitals ranged between 0.6% and 13% Ministry’s wait-time targets of 10 days and of scheduled appointments. In 2017/18, 28 days for these two groups. The remaining hospitals reported a total of 57,916 missed CT Chapter 3 • VFM Section 3.08 33% (not the intended 10%) waited longer appointments, but they were able to fill these (see Figure 9). slots with little difficulty. • Wait times for CT scans vary depending on where the patient lives in Ontario. The MRI and CT Scanning Services wait-time disparity for non-urgent patients The Ministry is unable to justify the was the most significant. Depending on • funding methods for MRI and CT scans, where a patient lives and the demand for CT which have remained unchanged for over scanning services in that LHIN, patients have 10 years. The Ministry has not reviewed its a shorter or longer wait than in other LHINs.