Planning beyond COVID-19

Balancing scheduled non-emergent and emergency surgeries with resources on hand is an operational challenge for most health systems. With the temporary freeze on conducting non-emergent surgical procedures following Alberta’s COVID-19 response, a backlog of operations has resulted forcing healthcare administrators to reassess surgical services. The Alberta Bone and Joint Health Institute (ABJHI) is assisting Alberta Health Services (AHS) Surgery Strategic Clinical Network (SSCN), Provincial Surgery Operations Committee, and Bone and Joint Health Strategic Clinical Network in analyzing wait lists for non-emergent surgeries carried out across the province. Hip and knee replacements, cataract surgery, gall bladder removal and hernia repair are just a few of the many procedures that must be scheduled far in advance.

As non-emergent surgeries resume under the Alberta Health Relaunch Strategy, ABJHI analysts are considering orthopedic wait lists in the long-term through hundreds of different simulation scenarios. Applying the methods ABJHI developed for modelling hip and knee arthroplasty wait times and using SSCN surgical coding standards, the scenarios outline the surgical volumes that could bring wait times within clinically-recommended targets for the different procedures.

How quickly the disease is progressing, pain experience and limitations to daily living activities are main factors for surgical prioritization, but there are additional considerations that add complexity. The list of reasons for why a patient’s surgery may be delayed is long (for example: a cardiac event, an infection, a new diagnosis, a vacation/wedding, a change in occupation, or acting as care-giver support for others). The coding standards—Alberta Coding Access Targets for Surgery—assist care teams in determining a patient’s urgency level but also help operational leadership understand surgical capacity needs across the province.

Using existing wait list information and estimating future demand from historical data, the simulation scenarios are just one of the tools being used by AHS to help Albertans manage the impacts of the pandemic.