This month’s column will explore challenges faced by
hospitals managing surgical services during COVID-19.
Hospital Operating Rooms are not traditionally known to be
flexible or nimble; they function like well-oiled machines. Scheduled
procedures happen daily, following predetermined processes and procedures for patient
safety. CCH utilizes five operating theatres, allowing for multiple surgeries
and the provision of emergency surgical care at any given time.
With the announcement
of the pandemic in March, all Ontario hospitals were directed to postpone scheduled
(or “elective”) surgeries. Despite COVID-19, CCH never closed our operating rooms
completely. We continued conducting necessary emergency procedures, interventions
for life-threatening illnesses, and operations where surgical delays would
severely impact a patient’s quality of life. Our medical teams always take these
decisions very seriously, having to prioritize the greatest surgical needs in
On May 26, 2020, the Ontario Ministry of Health announced a “gradual
restart of deferred services”. This meant hospitals like ours could begin
providing scheduled surgeries once again. It might sound easy to restart services
on-hold for a relatively short period of time, but to revisit the well-oiled
machine analogy, pre-pandemic surgical models required multiple updates to run
smoothly in our “new normal”. Perhaps the easiest way to shed light on changes we’ve
made to safely ramp-up scheduled surgeries is to take you on a patient’s
journey -- and that doesn’t start on the operating room table.
Once surgery is determined necessary, a surgeon’s office
will contact the hospital for scheduling. After a procedure is booked, our preparation
process begins. Weeks leading up to scheduled
surgeries, most patients come to CCH for pre-admission preparation, which can include
bloodwork, an electrocardiogram (ECG) or x-rays – and now this pre-admission
preparation includes a first COVID-19 screening.
Two weeks prior to scheduled procedures, surgeons instruct
patients to further reduce risk of COVID-19 exposure, following Ontario
Health’s guidelines of physical distancing, frequent hand washing and mask
wearing. Another COVID-19 screening occurs 3-4 days prior to surgery, and a
final screening is conducted upon arrival for the scheduled procedure.
COVID screening is important for two reasons, not only does
it help limit the spread of the virus, but we know that surgical risks to
patients with the virus can be significantly greater. If COVID-19 symptoms
arise prior to a scheduled procedure, patients must call the hospital and surgeon’s
office to reschedule. This may allow another patient to be booked, time
How does the hospital decide which rescheduled procedure comes
first? In caring for local patients, this question is of utmost importance as
we work to alleviate the backlog of surgeries due to COVID-19.
There’s always been a method to prioritize which surgeries
are performed first. Urgency, life threatening indicators and length of time to
safely delay procedures are all determining factors. Now, considerations like
PPE (Personal Protective Equipment) availability and COVID-19 screening are added
to the mix. Staffing availability and hospital bed capacity also play important
roles in how soon surgeries are scheduled.
Recent provincial funding announcements, including dollars
committed to addressing current surgical backlogs have been helpful and are
certainly appreciated. However, there are challenges beyond funding. Other
critical resources are also necessary. Qualified Registered Nurses trained to
work in operating rooms are in limited supply, and each can only work so many
hours a week. To serve patients safely, rest between each shift is mandatory.
Surgeons, too, can only operate so many hours on top of clinic and office
Versatile use of physical space helps us manage when bed
occupancy is high. More “day surgery” procedures alleviate pressure on hospital
accommodations. Offering orthopaedic surgery on weekends when staffing and
scheduling allow, helps too. Our surgeons, nurses and staff are working hard to
address pandemic-related backlogs for the good of our patients.
Will surgical wait times continue to be impacted by our
pandemic state? Of course. If the prevalence of COVID-19 becomes unmanageable, it’s
realistic that hospitals may need to reduce surgical activity again. Whatever
the case, be assured that our dedication to our patients will continue guiding
us as we navigate this unchartered territory.
Patient and Family Advisory Committee
Mental Health Crisis Line: 1-866-996-0991 (16 years and up)