Wait times for heart imaging tests reach 5-year high in Winnipeg

Wait times for heart imaging scans have reached a five-year high as Winnipeg hospitals grapple with a nuclear medicine program under pressure to complete more tests with less staff and less equipment. 

Patients at Health Sciences Centre are now waiting triple the time for myocardial perfusion tests (often known as nuclear stress tests) after wait times ballooned from six weeks to 18 weeks in less than a year.

This is the the longest recorded wait in the past five fiscal years, according to data from Manitoba Health. 

"And we're finding it quite a struggle," said Jeremy Phipps, HSC's manager of nuclear medicine and member of the Manitoba Association of Medical Radiation Technologists.

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Union and health officials say Winnipeg's nuclear medicine system (which is a branch of medicine imaging that uses radioactive materials to diagnose patients) is in disarray. 

"It's worrisome. Staffing is so stretched and they are doing what they can and working a lot of overtime and we are still falling behind," said Bob Moroz, the president of the Manitoba Association of Health Care Professionals (MAHCP).

"It is really indicative of the pressures across the entire system ... there are less of us and we are working longer hours."

Patients waiting 13 weeks at St. Boniface

Phipps describes the last year as one full of changes that impacted the department's ability to complete routine and non-urgent nuclear medicine scans in a timely manner. 

Myocardial perfusion studies are the only nuclear scans that are tracked monthly by Manitoba Health.

These scans involve injecting radioactive material into a vein to produce images that show blood flow or damage to the heart. This scan, along with other nuclear medicine scans, requires the use of a specialized camera known as a gamma camera.

Two of those cameras were pulled from service in September when Seven Oaks Hospital decommissioned its camera and when the Medical Arts Building was closed. 

"It's sort of the combination of having a clinic closing and having a hospital nuclear medicine department closing as well," said Phipps.

"We're just really not used to having to, you know, rearrange a schedule to make time for urgent scans."

The lion's share of nuclear stress tests are performed at HSC (which performs about 180 tests a month) and St. Boniface, which performs about 140 a month.

Patients are waiting 13 weeks for non-urgent stress tests at St. Boniface, which is also a five-year high for the hospital. 

Four cameras decommissioned in five years: union

The current average wait time for all of Winnipeg for nuclear stress tests is 15 weeks — another five-year high for the city.

A nuclear stress test is designed to give doctors a window into the blood circulation in a patient's heart, explained William Leslie, a professor at the University of Manitoba and doctor within St. Boniface Hospital's nuclear medicine department.

It involves injecting radioactive material into a vein to produce images that show blood flow or damage to the heart.

"It helps us to see if there is a healthy blood flow to the heart, whether there has been an area that has been damaged, say from a heart attack," he said.  

In the past five years, a quarter of the cameras once available for nuclear medicine scans in Winnipeg have been decommissioned, according to data provided by the MAHCP. Grace Hospital went from two cameras to one in the past five years, and during that same period the Winnipeg Clinic stopped operating its gamma camera.

A request for comment from the Winnipeg Clinic's CEO was not returned by press time. 

Minister pledges to increase staffing hours at Victoria Hospital 

"Essentially, we are doing the same number of hours, with four less cameras. So the mathematics are quite simple and wait times are going to be impacted by that," said Moroz. 

The MAHCP represents nuclear medicine technologists at both hospitals. 

"They [workers] feel it and quite frankly they are all a bit embarrassed by it. This is their chosen career and they are not able to keep up and that is hard on a professional," he said.  

Health Minister Cameron Friesen declined an interview request, but in a prepared statement he acknowledged that wait times have increased, "particularly at HSC Winnipeg."

If we don't have enough staff to open the camera then that means that cameras isn't scanning patients so it puts delays on the system that way- Jeremy Phipps, manager of Nuclear medicine at HSC

"Additional staffing hours are being implemented at Victoria General Hospital which will increase the number of nuclear medicine exams performed, including myocardial perfusion scans, as efforts are made to reduce the current backlog," he said.

"These measures and improvements made to schedule patients in a more efficient manner should help to address current wait time pressures."

The number of scans performed in Winnipeg has increased by about 12 per cent in the past five years. 

Manitoba Liberal MLA Jon Gerrard calls the wait times unacceptable.

Gerrard, who is also a doctor, says these tests are essential to understanding how a heart is functioning.

"It is really distressing to see the wait time has tripled in the last little while," he said.

"This is vital and 18 weeks is way too long."

No staff means cameras not always used

Staffing shortages have meant that over the past few months there have been days where some of the gamma cameras couldn't be utilized, said Phipps.

"We have more open positions than we have technologists," he said. "Once a week you'd have a camera not scanning, which means usually five to seven patients aren't being done on that camera."

Phipps says because nuclear medicine is so specialized, it requires extra training. Training that is unavailable in Winnipeg, so staff must be sent to Calgary. He says HSC is working to increase the number of people in the training program to combat the shortages.

"If we don't have enough staff to open the camera then that means that camera isn't scanning patients, so it puts delays on the system that way," Phipps said.

Moroz said staffing within both hospitals is stretched and positions aren't being filled. He says in the past, the hospitals have had to shut down a camera in order to give staff a lunch break. 

"It is not easy to recruit folks when there are higher salaries and different workloads elsewhere," he said. 

A spokesperson for Shared Health — the newly created provincial health organization in charge of diagnostic services — says it is currently recruiting to fill one vacant position due to medical/maternity leave.

"Staffing issues to date [maternity and medical leaves] have not resulted in the cancellation of any scheduled nuclear medicine appointments," she said in a prepared statement.

Patients waiting for other nuclear medicine scans

Phipps said that routine scans such as bone scans and nuclear heart scans — exams HSC's Nuclear Medicine department used to do with two days' notice — are now taking three weeks in non-urgent cases.

"We used to always just be able to, you know, find spots for them pretty quickly so it's just more challenging to schedule."

Shared Health says that as of May 8, patients were waiting three weeks for bone, multigated acquisition (another form of heart imaging), and renal scans. There is no historic data for these tests.

Moroz says because of the backlog of routine tests not being completed, staff are doing voluntary overtime to make up the difference.

"The problem is I don't see how we are going to catch up with it. How do you catch up if our equipment is disappearing and we don't have the staff to fill it right now," he said. 

Darlene Jackson, president of the Manitoba Nurses Union, says she has also heard from her members that certain nuclear medicine procedures that are not publicly tracked have seen wait times increase.

Manitoba NDP leader Wab Kinew says this is a sign that the government is moving too fast on changes to the healthcare system.

"The cutbacks, the staffing shortages, the selling off of public assets are leading to higher and higher wait times," he said.

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