Delivery and Prioritization of Surgical Care in Canada During COVID-19: An Environmental Scan

Document Type : Original Article

Authors

1 Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

2 Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

3 Surgery Strategic Clinical Networks, Alberta Health Services, Calgary, AB, Canada

4 Surgery and Bone & Joint Health Strategic Clinical Networks, Alberta Health Services, Calgary, AB, Canada

5 Department of Oncology and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

Abstract

Background 
During COVID-19 healthcare systems had to make concessions to make room for the surge of COVID-19 patients requiring hospital and intensive care. Postponing surgeries was a common strategy; however, it is unclear how surgical care was delivered during this time of constraint. The objective of this study was to understand how surgical care was delivered and prioritized during the COVID-19 pandemic response.
 
Methods 
This was an environmental scan following the Canadian Agency for Drugs and Technologies in Health methodology. This study was conducted in Canada; a universal, publicly funded healthcare system. Evidence sources on policies pertaining to the provision of surgical care between January 2020 and October 2022 were obtained from ministries of health, health services agencies and publicly funded hospitals across all 10 provinces and three territories. We synthesized the evidence sources using framework analysis.
 
Results 
We identified 205 evidence sources that described six themes about the provision of surgical care during the COVID-19 pandemic: the cycle of postponement and resumption; guidelines for triaging and prioritizing surgical cases; Infection Prevention and Control (IPAC), and safety measures for surgical care during COVID-19, patient-centred care, and looking forward (recovery planning, leadership, and decision-making).
 
Conclusion 
This study provides a comprehensive understanding of how surgical care was disrupted and innovated during COVID-19 which can inform future strategies for providing effective and efficient surgical care during times of healthcare constraint.

Keywords

Main Subjects

References

  1. Haldane V, De Foo C, Abdalla SM, et al. Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries. Nat Med. 2021;27(6):964-980. doi:1038/s41591-021-01381-y
  2. Moynihan R, Sanders S, Michaleff ZA, et al. Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review. BMJ Open. 2021;11(3):e045343. doi:1136/bmjopen-2020-045343
  3. O'Rielly C, Ng-Kamstra J, Kania-Richmond A, et al. Surgery and COVID-19: a rapid scoping review of the impact of the first wave of COVID-19 on surgical services. BMJ Open. 2021;11(6):e043966. doi:1136/bmjopen-2020-043966
  4. Canadian Institute for Health Information (CIHI). Patients in Canada Continue to Experience Longer Wait Times for Surgery During COVID-19 Pandemic. CIHI; 2022. https://www.cihi.ca/en/news/patients-in-canada-continued-to-experience-longer-wait-times-for-surgery-during-covid-19.
  5. Wang J, Vahid S, Eberg M, et al. Clearing the surgical backlog caused by COVID-19 in Ontario: a time series modelling study. CMAJ. 2020;192(44):E1347-E1356. doi:1503/cmaj.201521
  6. Urbach DR, Martin D. Confronting the COVID-19 surgery crisis: time for transformational change. CMAJ. 2020;192(21):E585-E586. doi:1503/cmaj.200791
  7. Forner D, Murnaghan S, Porter G, et al. Psychosocial distress in adult patients awaiting cancer surgery during the COVID-19 Pandemic. Curr Oncol. 2021;28(3):1867-1878. doi:3390/curroncol28030173
  8. Sauro KM, Smith C, Kersen J, et al. The impact of delaying surgery during the COVID-19 pandemic in Alberta: a qualitative study. CMAJ Open. 2023;11(1):E90-E100. doi:9778/cmajo.20210330
  9. Jaworska N, Schalm E, Kersen J, et al. The impact of delayed nonurgent surgery during the COVID-19 pandemic on surgeons in Alberta: a qualitative interview study. CMAJ Open. 2023;11(4):E587-E596. doi:9778/cmajo.20220188
  10. Beesoon S, Bakal JA, Youngson E, et al. Excess deaths during the COVID-19 pandemic in Alberta, Canada. IJID Reg. 2022;5:62-67. doi:1016/j.ijregi.2022.08.011
  11. Parmar A, Eskander A, Sander B, Naimark D, Irish JC, Chan KKW. Impact of cancer surgery slowdowns on patient survival during the COVID-19 pandemic: a microsimulation modelling study. CMAJ. 2022;194(11):E408-E414. doi:1503/cmaj.202380
  12. Lee WE, Park SW, Weinberger DM, et al. Direct and indirect mortality impacts of the COVID-19 pandemic in the US, March 2020-April 2021. medRxiv [Preprint]. February 15, 2022. Available from: https://pubmed.ncbi.nlm.nih.gov/35194617/.
  13. Vatanpour S, D’Souza A, Southern D, Ibadin S, Eastwood C, Sauro KM. The impact of delaying non-urgent surgeries on healthcare resource utilization during COVID-19: A retrospective cohort study. Canadian Association of Health Services and Policy Research (CAHSPR); 2023; Montreal, Québec, Canada. Abstract 759.
  14. Rennert-May E, Leal J, Thanh NX, et al. The impact of COVID-19 on hospital admissions and emergency department visits: a population-based study. PLoS One. 2021;16(6):e0252441. doi:1371/journal.pone.0252441
  15. Bouthillier ME, Lorange M, Legault S, et al. Prioritizing surgery during the COVID-19 pandemic: the Quebec guidelines. Can J Surg. 2021;64(1):E103-E107. doi:1503/cjs.022220
  16. Brindle ME, Gawande A. Managing COVID-19 in surgical systems. Ann Surg. 2020;272(1):e1-e2. doi:1097/sla.0000000000003923
  17. Farah E, Ali R, Tope P, El-Zein M, Franco EL. A review of Canadian cancer-related clinical practice guidelines and resources during the COVID-19 pandemic. Curr Oncol. 2021;28(2):1020-1033. doi:3390/curroncol28020100
  18. Finley C, Prashad A, Camuso N, et al. Guidance for management of cancer surgery during the COVID-19 pandemic. Can J Surg. 2020;63(22):S2-S4. doi:1503/cjs.005620
  19. Wiebe K, Kelley S, Kirsch RE. Revisiting the concept of urgency in surgical prioritization and addressing backlogs in elective surgery provision. CMAJ. 2022;194(29):E1037-E1039. doi:1503/cmaj.220420
  20. Gomez D, Dossa F, Sue-Chue-Lam C, et al. Impact of COVID 19 on the provision of surgical services in Ontario, Canada: population-based analysis. Br J Surg. 2021;108(1):e15-e17. doi:1093/bjs/znaa043
  21. Shapiro J, Axelrod C, Levy BB, Sriharan A, Bhattacharyya OK, Urbach DR. Perceptions of Ontario health system leaders on single-entry models for managing the COVID-19 elective surgery backlog: an interpretive descriptive study. CMAJ Open. 2022;10(3):E789-E797. doi:9778/cmajo.20210234
  22. Simpson AN, Gomez D, Baxter NN, et al. Patient, family and professional suggestions for pandemic-related surgical backlog recovery: a qualitative study. CMAJ Open. 2023;11(2):E255-E266. doi:9778/cmajo.20220109
  23. Stafinski T, Nagase FN, Brindle ME, et al. Reducing wait times to surgery—an international review. J Hosp Manag Health Policy. 2022;6:29. doi:21037/jhmhp-21-96
  24. Government of Canada. Canada's Health Care System. Vol 2022. Government of Canada; 2022.
  25. Allin S, Sherar M, Church Carson M, et al. Public Management and Regulation of Contracted Health Services. Toronto: North American Observatory on Health Systems and Policies; 2020.
  26. Rowel R, Moore ND, Nowrojee S, Memiah P, Bronner Y. The utility of the environmental scan for public health practice: lessons from an urban program to increase cancer screening. J Natl Med Assoc. 2005;97(4):527-534.
  27. Canadian Agency for Drugs & Technologies in Health (CADTH). Environmental Scan Process. CADTH; 2015.
  28. Canadian Institute for Health Information (CIHI). Hospital Beds Staffed and In Operation, 2019-2020. Ottawa, ON: CIHI; 2021.
  29. Government of Canada. COVID-19 Epidemiology Update: Key Updates. https://health-infobase.canada.ca/covid-19/. Accessed November 7, 2022.
  30. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13:117. doi:1186/1471-2288-13-117
  31. Santana MJ, Manalili K, Jolley RJ, Zelinsky S, Quan H, Lu M. How to practice person-centred care: a conceptual framework. Health Expect. 2018;21(2):429-440. doi:1111/hex.12640
  32. Scholl I, Zill JM, Härter M, Dirmaier J. An integrative model of patient-centeredness - a systematic review and concept analysis. PLoS One. 2014;9(9):e107828. doi:1371/journal.pone.0107828
  33. McMahon M, Nadigel J, Thompson E, Glazier RH. Informing Canada's health system response to COVID-19: priorities for health services and policy research. Healthc Policy. 2020;16(1):112-124. doi:12927/hcpol.2020.26249
  34. Gibney RTN, Blackman C, Gauthier M, et al. COVID-19 pandemic: the impact on Canada’s intensive care units. Facets (Ott). 2022;7:1411-1472. doi:1139/facets-2022-0023
  35. COVIDSurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. Br J Surg. 2020;107(11):1440-1449. doi:1002/bjs.11746
  36. Balas M, Vasiliu D, Austria G, Felfeli T. The impact of the COVID-19 pandemic on wait-times for ophthalmic surgery in Ontario, Canada: a population-based study. Clin Ophthalmol. 2023;17:1823-1831. doi:2147/opth.s409479
  37. Stephenson R, Sarhangian V, Park J, et al. Evolution of the surgical procedure gap during and after the COVID-19 pandemic in Ontario, Canada: cross-sectional and modelling study. Br J Surg. 2023. doi:1093/bjs/znad289
  38. Tran C, Cipriano LE, Driman DK. Impact of COVID-19-related health care disruptions on pathologic cancer staging during the first pandemic year: a retrospective cohort study from March 2018 to March 2021. CMAJ Open. 2023;11(3):E475-E484. doi:9778/cmajo.20220092
  39. Forse CL, Petkiewicz S, Teo I, et al. Negative impact of COVID-19 associated health system shutdown on patients diagnosed with colorectal cancer: a retrospective study from a large tertiary center in Ontario, Canada. J Can Assoc Gastroenterol. 2022;5(3):137-142. doi:1093/jcag/gwab044
  40. Nagase FN, Stafinski T, Brindle ME, et al. Reducing the wait for surgical consultation—what works and what doesn’t?—a review of selected countries in North America, Europe and Australasia. J Hosp Manag Health Policy. 2022;6:28. doi:21037/jhmhp-21-95
  41. van den Heuvel B, Vair B, Porter G, Klassen D, Inglis K, Bonjer HJ. Patient compliance with a group model of care: the hernia clinic. Can J Surg. 2012;55(4):259-263. doi:1503/cjs.002811
  42. Common JL, Mariathas HH, Parsons K, et al. Reducing wait time for lung cancer diagnosis and treatment: impact of a multidisciplinary, centralized referral program. Can Assoc Radiol J. 2018;69(3):322-327. doi:1016/j.carj.2018.02.001
  43. Wilgenbusch CS, Wu AS, Fourney DR. Triage of spine surgery referrals through a multidisciplinary care pathway: a value-based comparison with conventional referral processes. Spine (Phila Pa 1976). 2014;39(22 Suppl 1):S129-135. doi:1097/brs.0000000000000574
  44. Hovlid E, Bukve O, Haug K, Aslaksen AB, von Plessen C. A new pathway for elective surgery to reduce cancellation rates. BMC Health Serv Res. 2012;12:154. doi:1186/1472-6963-12-154
  45. Dautremont JF, Rudmik LR, Nakoneshny SC, et al. Understanding the impact of a clinical care pathway for major head and neck cancer resection on postdischarge healthcare utilization. Head Neck. 2016;38 Suppl 1:E1216-1220. doi:1002/hed.24196
  46. Kirkwood BJ, Pesudovs K, Latimer P, Coster DJ. The efficacy of a nurse-led preoperative cataract assessment and postoperative care clinic. Med J Aust. 2006;184(6):278-281. doi:5694/j.1326-5377.2006.tb00237.x
  47. Aiken AB, Harrison MM, Atkinson M, Hope J. Easing the burden for joint replacement wait times: the role of the expanded practice physiotherapist. Healthc Q. 2008;11(2):62-66. doi:12927/hcq.2008.19618
  48. Basabih M, Prasojo E, Rahayu AYS. Hospital services under public-private partnerships, outcomes and, challenges: a literature review. J Public Health Res. 2022;11(3):22799036221115781. doi:1177/22799036221115781
  49. Baxter D, Casady CB. Proactive and strategic healthcare public-private partnerships (PPPs) in the coronavirus (COVID-19) epoch. Sustainability. 2020;12(12):5097. doi:3390/su12125097
  50. Damani Z, Conner-Spady B, Nash T, Tom Stelfox H, Noseworthy TW, Marshall DA. What is the influence of single-entry models on access to elective surgical procedures? A systematic review. BMJ Open. 2017;7(2):e012225. doi:1136/bmjopen-2016-012225
  51. Wensing M, Sales A, Armstrong R, Wilson P. Implementation science in times of COVID-19. Implement Sci. 2020;15(1):42. doi:1186/s13012-020-01006-x
  52. Rosenbaum L. The untold toll - the pandemic's effects on patients without COVID-19. N Engl J Med. 2020;382(24):2368-2371. doi:1056/NEJMms2009984
  53. Christino MA, Sanborn RM, Miller PE, et al. COVID-delayed elective surgery has a negative effect on young sports medicine patients. Arthrosc Sports Med Rehabil. 2022;4(4):e1377-e1384. doi:1016/j.asmr.2022.05.001
  54. Gagliardi AR, Yip CYY, Irish J, et al. The psychological burden of waiting for procedures and patient-centred strategies that could support the mental health of wait-listed patients and caregivers during the COVID-19 pandemic: a scoping review. Health Expect. 2021;24(3):978-990. doi:1111/hex.13241
  55. Jack K, Evans C, Bramley L, et al. Identifying and understanding the non-clinical impacts of delayed or cancelled surgery in order to inform prioritisation processes: a scoping review. Int J Environ Res Public Health. 2022;19(9):5542. doi:3390/ijerph19095542

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History

  • Receive Date: 03 March 2023
  • Revise Date: 29 September 2023
  • Accept Date: 20 November 2023
  • First Publish Date: 22 November 2023

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