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

Clyde Matava; Jeannette So; R J Williams; Simon Kelley; ORRACLE-Xtra Group

doi:10.2196/35584

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

JMIR Perioper Med. 2022 Mar 15;5(1):e35584. doi: 10.2196/35584.

Authors

Clyde Matava¹, Jeannette So², R J Williams¹, Simon Kelley^{3

4}; ORRACLE-Xtra Group⁵

Collaborators

ORRACLE-Xtra Group:
Andrea Sepa, Angela Domingues, Lisa Pendergast, Julianne Godden, Andrew Jarvis

Affiliations

¹ Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON, Canada.
² Perioperative Services, Hospital for Sick Children, Toronto, ON, Canada.
³ Division of Orthopedic Surgery, Hospital for Sick Children, Toronto, ON, Canada.
⁴ Department of Surgery, University of Toronto, Toronto, ON, Canada.
⁵ See Acknowledgments, .

PMID: 34887242
PMCID: PMC8929408
DOI: 10.2196/35584

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.

Keywords: COVID-19; Canada; ambulatory surgery; pandemics; patient satisfaction; quality improvement; waiting lists.

©Clyde Matava, Jeannette So, RJ Williams, Simon Kelley, ORRACLE-Xtra Group. Originally published in JMIR Perioperative Medicine (http://periop.jmir.org), 15.03.2022.