Studying the Impact of COVID-19 on Surgical Care Delivery: Development of Approaches to Enhance Care and Efficiency

It is estimated that 350,000 inpatient surgeries and 1.2 million outpatient procedures are conducted in Ontario’s 228 hospitals [1]. Due to the COVID-19 pandemic and the subsequent re-allocation of resources, most surgical procedures have been put on hold in Ontario and elsewhere. Access to surgical care is at best limited and dependent on resources that are currently in critical demand. The ongoing response to the pandemic is adding to the pre-existing backlog of patients, many of whom have progressive pathologies with no alternative treatments. The demand for surgical care in the subsequent months and in the aftermath of the pandemic will be unprecedented. There are no guidelines or strategies to address delays and cancellations at this scale. There is a critical need for information and optimal healthcare utilization strategies to assist surgeons and healthcare administrators faced with difficult decisions in allocating resources against a mounting surgical demand.

We aim to identify insufficiencies in the delivery of surgical care as a result of the COVID-19 pandemic and to develop strategies to mitigate these critical problems. The approach will involve analysis of real-time data from Toronto academic hospitals as well as provincial data available on the Institute for Clinical Evaluative Sciences (ICES) database. Through this analysis, we can identify patient populations and specialties most impacted by this health crisis. This knowledge can then be utilized through expert working groups to develop approaches to enhance the utilization of surgical resources. Recommendations include triaging protocols of elective surgeries in the aftermath of COVID-19 for elective procedures.

The efficient delivery of surgical care is also dependent on clinical visits which have been delayed or cancelled as a result of the COVID-19 pandemic. As a concurrent second aim of our project, we will implement a standardized approach to clinical visits on a virtual platform. We propose a three-tier system in which all patients would be first contacted via a phone call for initial triaging and to determine if they can proceed to a virtual video teleconference clinic appointment. From these assessments, we can identify those patients who would need to be seen in-person due to the medical urgency. An important step in our system is developing and validating clinical exams that can be administered virtually. These include novel functional assessments to assess strength, dexterity, balance, gait and coordination.

Our team consists of all the surgeon-in chiefs at the major academic hospitals, the chairman of the department of surgery and experts in large data analytics. This expert panel will allow for immediate policy-based solutions.

The benefits of this project will extend beyond the original goals of the initiative. The stress-induced by the current crisis has exposed critical flaws and allow for the development of guidelines to enhance equitable delivery. In the current crisis, barriers to care such as age, geography, and disability will be amplified and strategies to address those can be used in the future. The guidelines will also be a source of reference for future pandemics.

  1. Canadian Institute for Health Information. Inpatient hospitalizations: Volumes, Lengths of Stay, and Standardized Rates, QuickSt