Urgency Classifications

Saskatchewan uses urgency classifications to ensure that patients who need a CT exam receive it in a timely manner. The more urgent your exam is, the sooner you will receive it. Likewise, if your exam is considered medically non-urgent, you may wait longer depending on the number of other CT scans that are of a more urgent nature. There are 4 urgency levels, each with a wait time target for when the CT scan should be completed. Level 1 - Emergent: Targeted wait time: within 24 hours Examples: Strokes and unconscious patients in emergency. Level 2 - Urgent: Targeted wait time: 2 - 7 days Examples: Childhood seizures and possible organ injuries. Level 3 - Semi-Urgent: Targeted wait time: 8 - 30 days Examples: Investigation of tumors before surgery and suspected cancer growth. Level 4 - Non-Urgent: Targeted wait time: 30 - 90 days. Examples: Chronic back pain and chronic headaches.
http://www.health.gov.sk.ca/diagnostic-imaging-ct-wait-times

Guidelines for Prioritization of Computed Tomography (CT) Scan Studies

Level 1 Level 2 Level 3 Level 4 An examination immediately necessary to diagnose and/or treat Immediately to life-threatening disease. Such an examination will need to be 24 hours done either stat or not later than the day of the request. An examination indicated within one week of a request to 2 to 7 days resolve a clinical management imperative. An examination indicated to investigate symptoms of 8 to 30 days potentially life threatening importance. An examination indicated for long range management or for 31 to 90 days prevention.

These guidelines are based on the impact of imaging studies on intervention, and on patient management. Conditions for which imaging has a lesser impact on effective early intervention are ranked as a lower priority, while conditions which benefit from early diagnosis with imaging are ranked correspondingly higher. Preoperative and acutely ill patients are given a higher priority where imaging is useful for diagnosis or operative planning. If a requesting physician believes the booked time is inappropriate for the patient's condition, he/she should consult with the radiologist in the referring Medical Imaging Department. The wait times suggested for CT studies in the prioritization guidelines are the recommended maximum wait times for patients with the conditions listed, based on appropriate balance between current access and patient need. The actual wait times for patients may be different depending on demand and availability of scanning time. This guideline document is not designed to be all inclusive. The ultimate responsibility for prioritization rests with the attending radiologist after consultation with the referring physician. Also, within a given category, some conditions will be considered more urgent than others - they are not all equal, nor are they ranked within a category.

http://www.health.gov.sk.ca/diagnostic-imaging-ct-prioritization

Level 1 Guidelines for Prioritization of CT Scan Studies

Level 1 - Stat to 24 hours

Imaging is critical for the immediate management of the patient. The patient/case should be directly discussed with the Radiologist. This includes Inpatients, Outpatients, and Emergency patients.

NEURO

Unconscious, altered or decreasing level of consciousness, or high risk with suspected intracranial pathology Severe trauma TIA/Stroke for thrombolysis or anticoagulation to rule out intracranial hemorrhage Patient with decreasing level of consciousness Suspected subarachnoid hemorrhage Suspected acute hydrocephalus / blocked shunt Stable trauma Intraorbital foreign body Subacute airway obstruction (Ped + Adult) Suspected dural sinus / thrombosis (if MRI contraindicated) Neck or intracranial infection

SPINE

Cauda equina syndrome / suspected cord compression (ideally imaged with MRI) Spinal injury (facture / dislocation) Post myelogram

ABDOMEN

Unstable major trauma Aortic dissection Ruptured abdominal aortic aneurysm Trauma Suspected intra-abdominal abscess (with sepsis) Retroperitoneal haemorrhage Acute surgical abdomen / intra-abdominal crisis Acute aortic dissection Significant chest trauma Acute PE Acute mediastinitis Malignancies usually associated with airway compromise (Ped)

CHEST

http://www.health.gov.sk.ca/diagnostic-imaging-level1-ct-guidelines

Level 2 Guidelines for Prioritization of CT Scan Studies

Level 2 - 2 to 7 days
Lesions/Disease processes in which the diagnosis is known and immediate treatment is not necessary, or lesions/disease processes which by history and physical findings do not require immediate treatment but do require prompt evaluation. The results of the CT study will likely alter patient management and provide additional information for surgical or medical management.

NEURO

Post-op neurosurgical patients in absence of acute deterioration Facial fractures / orbital trauma (Ped)

Suspected NAT (Ped) First onset seizures Discitis / osteomyelitis

NEURO - Head & Neck

Routine follow-up of intracranial disease Acute onset psychoses, first episode in young adults Acute onset psychoses, late onset after age 50 Acute onset psychoses with any atypical presentation of speech, profound thought disorder, visual hallucinations Acute proptosis

ABDOMEN

Abscess drainage CT KUB and CT Diverticulitis Indeterminate soft tissue organ injury Newborns with suspected CCAM / Diaphragmatic Hernia on plain films (Ped) Immunocompromised patients for infection (fungal) (Ped)

MUSCULOSKELETAL

Calcaneal fractures Pelvic fractures Tibial fractures Humoral fractures Femoral head fractures Post-op dislocated hip (MRI preferred) (Ped)

http://www.health.gov.sk.ca/diagnostic-imaging-level2-ct-guidelines

Level 3 Guidelines for Prioritization of CT Scan Studies

Level 3 - 8 to 30 days
Lesions/Disease processes in which the diagnosis is known and immediate treatment is not necessary, or lesions/disease processes which by history and physical findings do not require immediate treatment and delays in CT evaluation will not negatively affect treatment outcomes. The results of the CT study will likely alter patient management and provide additional information for surgical or medical management.

NEURO - Head & Neck

Pre-operative investigation, e.g. staging metastatic workup Suspected chronic subdural hematoma All patients with change in neurological signs Recent onset seizures Pre-op metastatic work-up Staging of malignant diseases prior to treatments such as chemotherapy or radiotherapy Head & neck tumors Acute sciatica with neurological findings Bone or spinal tumor (ideally imaged by MRI) Pre-op evaluation of tumors Post-op complications

SPINE

ABDOMEN

Pre-op evaluation of aneurysms Intra-abdominal inflammatory diseases Pediatric mass evaluation Search for primary tumors Renal cysts versus tumors Characterization of intra-abdominal masses or collections Adrenal masses Splenomegaly Oncology staging or investigation of a mass Pre-op evaluation of lung mass and/or biopsy Staging of known tumor Hilar lymphadenopathy Mediastinal mass Hemoptysis Acute interstitial lung disease Suspected cancer growth Biopsy of tumors Primary bone or soft tissue tumors Pre-op localization of joint pathology

CHEST

MUSCULOSKELETAL

http://www.health.gov.sk.ca/diagnostic-imaging-level3-ct-guidelines

Level 4 Guidelines for Prioritization of CT Scan Studies

Level 4 - Next available Routine Appointment slot 31 to 90 days
This category includes cases where CT is required for follow-up on patients with stable findings or patients in whom lesions/disease processes may undergo slow progression or those for which surgery is not required or limited therapeutic options are available.

NEURO

Chronic back pain with non specific signs Behaviour disorder Dementia Routine follow-up head/posterior fossa scans without clinical deterioration Follow-up sella without clinical deterioration (MRI preferred) Chronic headaches without neurological findings Follow-up seizure disorders Any atypical psychiatric presentation without acute onset Work-up for behaviour disorders TMJ pathology Familial aneurysms - CTA Head and back pathology Back pain with localizing signs Orbital pathology Temporal bones Sella pathology without neurological signs Paranasal sinus disease

Atypical psychiatric symptoms non-acute Unexplained chronic abdominal pain Follow-up aneurysm without clinical deterioration Fever of unknown origin Follow-up aneurysms without clinical deterioration Bronchiectasis Inhalational lung disease Interstitial lung disease Chronic PE Characterization of pulmonary nodule

ABDOMEN

CHEST

http://www.health.gov.sk.ca/diagnostic-imaging-level4-ct-guidelines

How Wait Times Are Calculated

This website provides the most recent diagnostic imaging wait time data available. Data is updated quarterly. Saskatchewan is in the process of changing its method of reporting wait times for diagnostic imaging services, to make its data more meaningful for patients, more accurate, and more comparable to national wait time reporting. New Reporting Method The new data will give patients a reasonable indication of when their procedures will occur: th 50 percentile data (50% completed within or "median") shows the number of days in which half of all patients seen waited. Half of patients receive service sooner, and half wait longer. th 90 percentile data (90% completed within) shows the number of days it took to provide service to the majority of patients. Only 10% of patients wait longer. Regina Qu'Appelle Health Region is the first health region to use the new reporting method, and Saskatoon is currently transitioning to the new method. Current Reporting Method Most health regions will continue to report "estimated maximum wait times" until they transition to the new method. Wait times are estimates based on the next available slot in the schedule, not on completed cases. (See Definitions below.) Each health region provides an estimated maximum wait time in days, rather than an average wait time. Generally, very few patients wait longer than the reported wait time. Definitions Wait time - The number of days between the date an imaging department receives a request for an examination, and the date the examination is scheduled. th Median (50 percentile) - The number of days by which half of patients have received their test, and the other half are still waiting. th 90 Percentile - The number of days by which 90% of patients have received their test. Only 10% of patients wait longer. Data Notes th Median and 90 percentile data is calculated using actual wait times of completed cases within the most recent th th month. The median (50 percentile or very middle number) and 90 percentile are reported. Data Included: all completed wait list entries with a procedure date falling within the date range. Data Excluded: procedures with a Priority 1 (emergency) urgency rating; cases identified as "follow-up" or "specified date procedures" (scheduled for a specific time frame in future)

http://www.health.gov.sk.ca/diagnostic-imaging-wait-time-calculation

Factors Affecting Wait Times

Wait times are affected by factors such as capacity (the resources a hospital has available for exams) and demand (the number of patients waiting for an exam). Capacity and demand vary among health regions. If you are waiting for a CT exam and are willing and able to travel to another health region for your exam, contact your physician about the possibility of having your referral sent to that region.

A patient's urgency classification may also affect the wait time. Urgency classifications are determined by a patient's condition based on clinically appropriate wait times. A patient's urgency (how quickly they need a diagnostic imaging exam) is determined by the physician who orders the exam. However, the ultimate responsibility for prioritization rests with the attending radiologist after consultation with the referring physician.

http://www.health.gov.sk.ca/diagnostic-imaging-wait-time-factors

2012