Reducing COVID-19–related surgical backlog using innovative models of service delivery

Reviewed by Emily Henderson, B.Sc.Jul 29 2022

JMIR Publications recently published "A Canadian Weekend Elective Pediatric Surgery Program to Reduce the COVID-19–Related Backlog: Operating Room Ramp-Up After COVID-19 Lockdown Ends-;Extra Lists (ORRACLE-Xtra) Implementation Study" in JMIR Perioperative Medicine which reported that a decrease in surgical services led to substantial backlogs for time-sensitive scheduled pediatric patients.

The overall goals were to increase patient access to surgery, improve operating room efficiencies, and optimize parent and staff experience.

The Operating Room Ramp-Up After COVID Lockdown Ends-Extra Lists (ORRACLE-Xtra) program led to 247 patients receiving surgery during the pilot period, resulting in a 5% decrease in the total number of patients on their waitlist with Pediatric Canadian Access Targets for Surgery IV, with 38.1% out-of-window of provincial targets.

Through the ORRACLE-Xtra pilot program, the JMIR Perioperative Medicine authors have shown that hospitals impacted by COVID-19 can reduce the surgical backlog using innovative models of service delivery in a Canadian context.

Sustained funding is critical to achieving more meaningful reductions in wait times for scheduled surgeries over the longer term and needs to be balanced with staff well-being.

The COVID-19 pandemic caused by the SARS-COV-2 virus has resulted in unprecedented challenges for the health care system."

Dr. Simon Kelley

In children, surgical delays are a source of significant morbidity because of three key issues:

1. Timing of surgery has a critical impact on the growth and development of the child
2. Treatable conditions may deteriorate over time because of the effects of growth, and
3. Excessive surgical wait times may result in the need to perform more complex surgeries than were initially planned, leading to an increase in avoidable complications

Due to the mandated reduction in surgical activity, the surgical wait list at their institution increased by 29% from 3799 to 4915 patients by the end of December 2020. This increase was despite a successful increase in surgical activity from July 2020. The Pediatric Canadian Access Targets for Surgery use diagnosis-based categories to define time-based targets for completing scheduled pediatric surgeries.

Using novel machine learning algorithms, the authors demonstrated that even on resuming their usual level of surgical activity, the surgical wait list would not decrease without a substantial increase in resources.

New JMIR Periop Med: A Canadian Weekend Elective Pediatric #surgery Program to Reduce the COVID-19–Related Backlog: Operating Room Ramp-Up After COVID-19 Lockdown Ends-;Extra Lists (ORRACLE-Xtra) Implementation #study https://t.co/0ljC0jVedN pic.twitter.com/BKmmUPND8C

-; JMIR Publications (@jmirpub) March 15, 2022

Thus, they recognized that an innovative program would be required to increase surgical activity above historical norms, specifically target low-acuity day-case procedures, and ultimately reduce the surgical backlog.

This pilot quality improvement project aimed to assess the feasibility of efficiently reducing the number of patients on the surgical wait list by scheduling elective surgeries on the weekends with a high level of satisfaction among participating parents and providers.

The SickKids Research Team concluded in their JMIR Publications Research Output, "through the ORRACLE-Xtra pilot program, we have shown that hospitals impacted by COVID-19 can use targeted MoH [Ministry of Health] funding to reduce the surgical backlog associated with the COVID-19 pandemic via the use of innovative models of service delivery. In addition, sustained institutional funding to expand the perioperative workforce is critical to achieving more meaningful reductions in wait times for scheduled surgeries over the longer term. Our institution and other pediatric institutions may find the information herein helpful for regular weekday work and future pandemics."