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 healthcare system. Ramp down of surgical services led to significant 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 were to increase patient access to surgery (and reduce the waitlist), improve operating room efficiencies, and optimize parent and staff experience. METHODS Using the DMAIC framework (define, measure, analyze, improve, control), we implemented ORRACLE-Xtra in a tertiary care academic pediatric hospital during a quiescence of the COVID-19 pandemic and 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 percent decrease in the total number of patients on our waitlist with P-CATS IV 59.5%, with 38.1% out-of-window of provincial targets. Most of the process and outcome measures were met or exceeded. Overall parental satisfaction was at 95.8% with staff reporting 79.1% satisfaction of working on the weekends. RESULTS ORRACLE-Xtra led to 247 patients receiving surgery during the pilot period resulting in a 5 percent decrease in the total number of patients on our waitlist with P-CATS IV 59.5%, with 38.1% out-of-window of provincial targets. Most of the process and outcome measures were met or exceeded. Overall parental satisfaction was at 95.8% with staff reporting 79.1% satisfaction of working on the 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. CLINICALTRIAL N/A.