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

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.