As MRI and CT wait lists spike in Alberta, auditor general calls for better guidelines, scheduling

As wait lists for MRI or CT scans in Alberta grow ever longer, the government must address the system's inefficient scheduling and inconsistent guidelines, the province's auditor general says.

An audit, tabled in the legislature Thursday, looked at the intake and scheduling process for Alberta Health Services' publicly-funded outpatient CT and MRI services.

Auditor general Doug Wylie said he found a system operating well below capacity with wait lists spiking over the past five years as funding fails to keep pace with growing demand. 

The wait list for a CT exam tripled over five years to 60,181 patients as of March 2020 while the queue for an MRI grew by 40 per cent to 66,183, Wylie's audit said. 

"Waiting for medically necessary care can have consequences for patients — our partners, our parents, our grandparents, and our children — and those who care for them, no matter where we live in Alberta," Wylie wrote.

A CT exam is typically used to monitor bone fractures, cancer and internal bleeding, while an MRI offers a more detailed image of the brain, spinal cord and soft tissue, with doctors using the scans to diagnose anything from tumours to torn ligaments. 

Albertans waited about 2.2 weeks longer than the national average for a CT exam and 5.7 weeks longer for an MRI, ranking Alberta first and third respectively for longest wait times among the provinces in 2019, according to a Fraser Institute survey cited in the audit. 

No centralized intake system

Alberta lacks a province-wide intake or scheduling system, with its five health zones effectively siloed from one another, Wylie said. 

Someone waiting for a high priority MRI in Edmonton, for example, could miss out on an available spot in Red Deer. 

In Calgary, the intake system is decentralized within the zone itself. Individual clinics cannot see the availability of other clinics to determine if an earlier time is available. 

There is also limited use of diagnostic tools that can help clinicians evaluate the medical necessity of an exam.

AHS says those tools will be included in the rollout of the province's new centralized digital-record-keeping system, Connect Care. But the audit found primary care and non-AHS physicians, who do the lion's share of referrals, will not have access to those tools. 

About 30 per cent of patients with lower back pain without any other red flags had at least one unnecessary x-ray or scan, the audit said.

The audit includes three recommendations: 

• Implement and measure the effectiveness of standard operational policy and work-flow for electronic order entry.
• Improve outpatient CT and MRI intake and scheduling. 
• Measure and report on performance to identify areas of improvement and promote best practices. 

Triage inconsistent: audit

The auditor found triage guidelines are not applied consistently with "thousands of examples" where patients assessed as lower-priority received an exam within the seven-day high-priority target, while high-priority patients waited in some cases for over 50 days. 

While wait times vary, most health zones are blowing past their targets for all priority groups, with only the Central and South zones meeting their high-priority targets for MRI exams. 

Calgary Zone had the longest wait times for all priority MRI exams. There, the lowest priority group can expect to wait about seven months longer than people in the Central Zone. 

"With annual demand expected to increase for CT and MRI exams by five and three per cent respectively, budgets are not keeping pace with demand, contributing to increased wait times," the audit found. 

Alberta is using about 33 per cent of its CT scan capacity and 58 per cent of its MRI capacity, if the machines were to operate at 17 hours a day, the audit found.

Alberta is near the bottom of all provinces when it comes to performing CT scans on weekends, and middle of the pack for MRIs. 

AHS performed a combined 646,682 MRI and CT exams in 2019 at a cost of around $172 million.

The Alberta government provided an additional $33 million in its latest budget to ease the backlog, but the audit notes one-time funding is not a long-term solution. To meet and maintain even double its target wait times, AHS estimated it will need $56.3 million in new annual funding.

In response to the audit, AHS said it has accepted the recommendations and is working on a three-year plan to minimize wait times, decrease costs and better manage existing data to more accurately estimate pressure on the system.