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Ontario unveils framework to allow hospitals to resume elective surgeries

Last Updated May 7, 2020 at 4:20 pm EDT

The Ford government says elective surgeries can resume again at hospitals across the province provided the procedures do not hamper the fight against COVID-19.

Health Minister Christine Elliott says a comprehensive framework has been developed to assess the readiness of hospitals to begin planning for the gradual resumption of scheduled surgeries and procedures, starting with the most urgent surgeries such as cancer and cardiac procedures.

“There may be some hospitals that decide to proceed with other procedures, whether it’s for cataract surgery, or whether it’s the hips, knees, joint replacement, some orthopedic issues. It will depend on what the hospital is able to do,” said Elliott.

In assessing whether elective and scheduled surgeries can resume, the framework says hospitals should: be in a community with a “manageable” and stable level of COVID-19; have adequate personal protective equipment and medication; and have enough inpatient and intensive care beds.

Hospitals should reserve 15 per cent of beds for COVID-19 patients and have a 30-day supply of protective gear on hand, the framework says.
Since March 15, all non-essential care and elective surgery has been on hold in order to allow hospitals across the province to focus on the fight against COVID-19.

“Ensuring our readiness to respond to all scenarios, even the worst, has required tough decisions,” said Elliott. “No decision was tougher than delaying surgeries. Especially cardiac and cancer surgeries. I know this has been very concerning to many people. Doing so, however, ensured our readiness to protect the health and well-being of Ontarians as we planned for a worst case scenario.”

The province’s Financial Accountability Office has estimated that between March 15 and April 22, up to 52,700 procedures were cancelled or avoided.

Up to 12,200 more procedures are delayed every week of the pandemic, the FAO said.

A report released by Toronto’s University Health Network last week estimated that 35 people may have died during the COVID-19 pandemic because their cardiac surgeries weren’t performed.

Ministry officials say there’s no timeline for when these procedures will be allowed to resume, but it will be up to existing regional and sub-regional COVID-19 steering committees to decide whether they are able to resume non-urgent surgeries, which include hip or knee replacements and cataract surgeries.

Doctors have previously expressed concerns about how they will be able to handle the backlog of elective surgeries once the coronavirus threat has subsided.

Dr. Sandy Buchman with the Canadian Medical Association said last month there will be very few ways for surgeons and hospitals to catch up once they start seeing elective patients again.

He said hospitals were operating above capacity before the pandemic, and wait times were already the bane of Canada’s health-care system.

That’s likely to mean patients waiting until their conditions are more serious or more advanced before they get into the operating room.

Health officials in British Columbia say it will take up to two years to clear up the backlog of elective surgeries postponed due to COVID-19, putting the number at 93,000. They are hoping to resume those procedures on May 18.

Minister Elliott did not provide a timeline or a figure on the number of urgent cases that are outstanding due to the delay, saying only “tens of thousands” of surgeries have been postponed. She added it could be “several weeks” before doctors can actually start performing those surgeries again.

As for the possibility of setting up COVID-free hospitals just to handle the backlog of elective surgeries, Elliott says it’s too soon to make that determination.

“It’s a possibility,” said Elliott. “It may be an individual hospital, it may be a region. I think its too soon to say just yet.”

Files from The Canadian Press were used in this report