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

Abstract

Background The COVID-19 pandemic caused by the SARS-COV-2 virus has resulted in unprecedented challenges for the health care system. A decrease of surgical services led to substantial backlogs for time-sensitive scheduled pediatric patients. We designed and implemented a novel pilot weekend surgical quality improvement project called Operating Room Ramp-Up After COVID Lockdown Ends—Extra Lists (ORRACLE-Xtra). Objective Our overall goals are to increase patient access to surgery (and reduce the wait list), improve operating room efficiencies, and optimize parent and staff experience. Methods Using the DMAIC (define, measure, analyze, improve, control) framework, we implemented ORRACLE-Xtra in a tertiary care academic pediatric hospital during a quiescent period of the COVID-19 pandemic. We defined process and outcome measures based on provincial targets of out-of-window cases. Parental and staff satisfaction was tracked by surveys. Results ORRACLE-Xtra led to 247 patients receiving surgery during the pilot period, resulting in a 5% decrease in the total number of patients on our wait list with Paediatric Canadian Access Targets for Surgery IV (147/247, 59.5%), with 38.1% (94/247) out-of-window of provincial targets. Most of the process and outcome measures were met or exceeded. Overall parental satisfaction was at 95.8% (110/121), with 79% (64/81) of staff reporting satisfaction with working weekends. Conclusions Through the ORRACLE-Xtra pilot program, we 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.

Impact of COVID-19 on Society of Urologic Oncology fellowship operative volumes

“…The ability to provide preoperative COVID testing, surgical prioritization systems, and increased operating hours were some of the strategies employed. [14] , [15] , [16] These strategies and the time dependent nature of many urologic oncology cases may have helped mitigate effects on SUO fellow case volumes.…”

Effect of COVID-19 on Graduating Urology Resident Case Logs: Analysis of the Accreditation Council of Graduate Medical Education National Data Reports

“… 17 Surgical backlogs prompted some institutions to adapt surgical prioritization systems and increase available operating hours. 18 , 19 The quick rebound aided by these interventions may have prevented significant effects to resident case logs.…”

Experiences of Health Care Professionals Working Extra Weekends to Reduce COVID-19–Related Surgical Backlog: Cross-sectional Study

“…Various models of increasing operating room throughput have been proposed to manage the COVID-19–related backlogs [ 8 , 14 - 18 ]. These include the triage of surgical patients for acuity and disease progression, longer operating hours during weekdays, addition of weekend surgical lists, or a combination of these [ 3 , 7 , 8 , 15 , 16 , 19 , 20 ].…”