Improving Healthcare in Ontario

The Province of Ontario is facing significant financial challenges.

 As public servants, Ontario’s Anesthesiologists remain committed to reducing healthcare costs while continually improving access to important medical care.

Collaborating, Ontario’s Anesthesiologists and other specialists, together with the Ontario Medical Association and the Ministry of Health and Long Term Care, found solutions to address the immediate need.

As we are on the front lines of healthcare, we believe we are best positioned to find efficiencies. Building on the success of the Anesthesia Care Team model, which we helped create and implement, Ontario’s Anesthesiologists will continue to consider and propose innovative models for the effective and efficient provision of care.

Anesthesia Care Teams: A History of Improving Access and Healthcare Efficiency

In 2003, Ontario was experiencing a significant shortage of anesthesiologists. Roughly 20 per cent of operating rooms were closed daily, and waiting lists for procedures such as cataract surgery were months long.

In response, the Section on Anesthesiology and the Ministry negotiated the Anesthesia Care Team model; which increased the number of professionals providing sedation, while decreasing the cost of this service overall.

This model created the new position of anesthesia assistants who now help provide safe, efficient sedation for cataract surgery under the supervision of anesthesiologists. This collaborative solution has drastically cut cataract waiting times to mere weeks, rather than months or years. The value of this program has been frequently heralded by Minister Matthews herself.

New Solutions for Ontario’s Future

In the first round of restructuring Ontario’s healthcare system, in April of 2012, the Ministry of Health identified cataract surgery as an area requiring attention. The OMA Sections on Anesthesiology and Ophthalmology are committed to continually improving the care we provide, and support the government’s effort to improve the productivity of the healthcare system.

Cost-saving methods of delivering anesthesia during cataract surgery can be developed. Many models already exist. To develop the best model for Ontario, which would both reduce costs and maintain access to this care, requires collaboration.

While the Ministry of Health did not agree to participate, the Sections on Anesthesiology and Ophthalmology have been working together to propose more sustainable options. Our first task was to summarize the standards for administering anesthesia during cataract surgery, as established by:

  • The College of Physicians and Surgeons of Ontario
  • The Canadian Anesthesiologists’ Society
  • The Canadian Ophthalmological Society, and, for further reference,
  • The American Academy of Ophthalmology

These standards are presented in A Joint Statement from the OMA Sections on Anesthesiology and Ophthalmology on Sedation Standards for Uncomplicated Cataract Surgery Under Topical Anesthesia.

Consensus among these organizations is that an appropriately trained individual, whose sole responsibility is to monitor the patient’s anesthesia, must attend all patients receiving intravenous sedation. In cases where an anti-anxiety pill is more appropriate than intravenous sedation, a suitably trained and dedicated individual must remain available to attend to any complications that could potentially arise. For more detail, please see A Joint Statement from the OMA Sections on Anesthesiology and Ophthalmology on the Current State of Cataract Anesthesia in Ontario.

With the standards for this care clearly established, the next step is to find efficiencies that meet these standards while also maintaining timely access, patient safety, and high levels of productivity. The Section on Anesthesiology endorses the new Physician Services Agreement, which was ratified on December 9, 2012, and encourages the Ministry of Health to join the Section and us on Ophthalmology in creating the best solution for Ontarians.

Together we can improve cataract care in Ontario.