Confronting the COVID-19 surgery crisis: time for transformational change

Urbach, David R.; Martin, Danielle

doi:10.1503/cmaj.200791

Cited by 49 publications

(63 citation statements)

References 12 publications

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“…To effectively manage this impact on more than 140 000 patients, health systems and surgical leaders cannot get back to business as usual, but rather must employ innovative system-based solutions to provide patients with timely surgical care and prepare for future COVID-19 waves. [31][32][33]…”

Section: Resultsmentioning

confidence: 99%

Clearing the surgical backlog caused by COVID-19 in Ontario: a time series modelling study

Wang

Vahid

Eberg

et al. 2020

CMAJ

141

163

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declared a global pandemic of coronavirus disease 2019 (COVID-19), which has exacted a massive global impact on health, politics and the economy. 1 With some jurisdictions past the peak of the first wave, the strain on the health care system is becoming apparent-specifically, the impact on surgical care. 2 The CovidSurg Collaborative estimated that 28 404 603 surgeries would be cancelled or postponed across 190 countries in the initial 12 weeks of COVID-19, including 37.7% of cancer surgeries and 81.7% of other (benign) surgeries. 3 If countries increased normal surgical volume by 20%, it would take a median of 45 weeks to clear the backlog. Modelling postpandemic recovery for elective orthopedic surgery in the United States suggested it would take 7-16 months to reach a steady state with a backlog of more than 1 million surgeries. 4 On Mar. 15, 2020, Ontario's Ministry of Health directed hospitals to begin a measured "ramping down of elective surgeries and other nonemergent clinical activity" in anticipation of a COVID-19 surge. 5 On May 26, 2020, the Ministry of Health lifted the directive, allowing hospitals to gradually increase elective and time-sensitive surgeries. 6 The reduction in nonemergent surgeries in Ontario because of COVID-19 has created a substantial surgical backlog. Our objective was to estimate the size of the nonemergent surgical backlog owing to COVID-19 in Ontario, and the time and resources required to clear this backlog. Methods The framework for developing these estimates is outlined in Figure 1. At the recommendation of our regional and hospital partners for feasible surge scenarios, we considered a +10% (1 d per week at 50% capacity) surge scenario, adding 8 hours per day incremental to a 5-day operating week. We included surgeries performed in a fully equipped operating room and categorized RESEARCH HEALTH SERVICES

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Section: Resultsmentioning

confidence: 99%

Clearing the surgical backlog caused by COVID-19 in Ontario: a time series modelling study

Wang

Vahid

Eberg

et al. 2020

CMAJ

141

163

View full text Add to dashboard Cite

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“…One in 8 women are expected to develop breast cancer during their lifetime, and one in 34 are expected to die of this disease as it is the number one cancer affecting women [ 2 ]. The Coronavirus Disease 2019 (COVID-19) pandemic has placed many strains on the Canadian health care system, in particular to the flow of operating rooms [ 3 ], a resource needed to treat breast cancer. Mitigation strategies for treatment of breast cancer were quickly developed to help deliver appropriate care during the pandemic [ 4 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…In British Columbia the operating room (OR) slow down started on March 16, 2020 and continued until May 4, 2020 allowing only urgent procedures, including oncology to proceed. Urbach and Martin describe that in Ontario, 45,000 fewer surgeries were performed in adults with non-cancer-related disease in March and April of 2020 (a more than 90% reduction compared to the same time period in 2019) [ 3 ]. They go on to suggest that single entry models and team-based care may be an effective way to reduce pandemic induced prolonged wait times [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 and breast cancer at a Regional Breast Centre: our flexible approach during the pandemic

Cadili

DeGirolamo

McKevitt

et al. 2020

Breast Cancer Res Treat

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Purpose In British Columbia (BC), there have been 2790 confirmed COVID-19 cases as of June 20, 2020. The aim of this project is to capture the effect of COVID-19 on the volume of surgery and adaptations to the surgical care of patients at a breast centre in BC. Methods All proven or suspected breast cancer cases treated with surgery between March 16, 2019 and April 30, 2019 and March 16, 2020 and April 30, 2020 through the Providence Breast Centre were included in this review. The date ranges in 2020 mark the early COVID-19 pandemic period in BC and the large shift in operating room access during this time. Results In 2019, 99 patients underwent surgery for proven breast cancer and 30 patients for suspected breast cancer. In 2020, 162 patients underwent surgery for breast cancer and 34 for suspected breast cancer. Wait times from core biopsy to surgery and surgery to oncology consultation were improved in 2020 with a reduction of core biopsy to surgery time from 58 to 28 days for patients seen during the pandemic. There was an increased use of regional anesthesia and same day discharge compared to 2019 with increases in regional anesthesia (41%–89%) and same day discharge (64%–86%) after adaptations to the pandemic were implemented. Conclusions Changes such as improved access to telemedicine, timing for cancer surgeries, and safer anesthetic techniques in response to the pandemic will change breast cancer surgical care beyond the pandemic era. Centralization and team-based care is the way forward.

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“…The systematic review for SEM also showed a consistently positive impact on access-related variables for referral of patients to surgical clinics (51). Recently, the combination of SEM and team-based care has been recommended as one way to confront the COVID-19 surgery crisis for e cient, fair, and ethical approaches in surgical care pathways (52). However, although this review has found promising results in regard to balancing the variation of total waiting time with SEM, it can be di cult to implement SEM into a referral system due to inadequate stakeholder readiness and participation (42).…”

Section: Discussionmentioning

confidence: 98%

The Effectiveness of Different Patient Referral Methods on Waiting Times for Adults Needing Elective Surgery - Systematic Review

Rathnayake¹,

Clarke²

2020

Preprint

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Background: Long waiting times and lengthy queues for elective surgery are common to many publicly funded health systems. Primary care practitioners play a major role in determining which patients are referred to the consultant surgeon and might represent an opportunity to improve this situation. With conventional methods of referrals, surgery clinics are often overcrowded with non-surgical referrals and surgical patients experience longer waiting times as a consequence. Improving the quality of referral communications should lead to more timely access and better cost-effectiveness for elective surgical care. This review summarises the research evidence for interventions within the scope of primary care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries.Methods: We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases in December 2019 to January 2020, for articles published after 2013. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer and cancer related surgeries. Randomised trials and non-randomised controlled studies were eligible. The main outcome variable of interest was waiting time for the elective surgery. The quality of evidence was assessed using ROBINS-I, AMSTAR 2 and CASP, as appropriate to the study method used. The review presentation was limited to a narrative synthesis because of heterogeneity. The PROSPERO registration number is CRD42019158455.Results: The electronic search yielded 7543 records. Finally, nine articles were considered as eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality, with one randomised trial, two quasi-experimental studies, two longitudinal follow up studies, three systematic reviews and one observational study. The included research showed that patient triage and prioritisation at the referral stage improved timely access and increased the number of consultations of surgical patients in clinics.Conclusions: The available studies included a variety of interventions and were of medium to high quality, showing that methods to improve the management of primary care referrals of patients for elective surgery can reduce waiting times and shorten waiting lists for elective surgery for adults.

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Confronting the COVID-19 surgery crisis: time for transformational change

Cited by 49 publications

References 12 publications

Clearing the surgical backlog caused by COVID-19 in Ontario: a time series modelling study

Clearing the surgical backlog caused by COVID-19 in Ontario: a time series modelling study

COVID-19 and breast cancer at a Regional Breast Centre: our flexible approach during the pandemic

The Effectiveness of Different Patient Referral Methods on Waiting Times for Adults Needing Elective Surgery - Systematic Review

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