How Manitoba may be able to tackle its surgical backlogs

Manitoba has assembled a task force to get surgical patient flow back on track — and with Omicron sweeping through the population, it'll have an even bigger job on its hands in 2022.

Before the highly transmissible coronavirus variant started wreaking havoc, the province estimated there were more than 152,000 surgical and diagnostic procedures on hold as of early December, thousands more than a month earlier. 

Then on Dec. 20, the province made the decision to put even more surgeries on ice as they sought to maintain ICU capacity in the face of rising case counts.

When the province finally is able to refocus its capacity on tackling the backlogs, there may be some lessons it could learn from British Columbia. 

B.C. announced its plan to deal with its surgical backlog early in the pandemic — in May 2020, before non-emergency surgeries resumed provincewide. In its July 2021 progress report, the B.C. government said 98.7 per cent of postponed procedures had been completed.

Here's a look at some of the initiatives that experts say B.C. and other places have used to try to reduce waitlists — and some of the caveats.

Create single wait list 

Andrew Longhurst, a health policy researcher in B.C., says one possible approach would be a single-entry model for referring patients to surgeons.

In both B.C. and Manitoba, for certain procedures, a physician refers a patient directly to an individual surgeon's wait list. The wait times between surgeons can vary dramatically. 

A single-entry model would centralize this intake process and could ease bottlenecks and varied wait times.

Longhurst compares it to waiting to see a bank teller: customers form a single centralized line and are seen by the first available teller. 

It's a solution that would be beneficial in the long term and help mitigate future backlogs, he said.

In its Dec. 8 news release, the Manitoba government said its task force was considering "creating a centralized information management system."

In an email response to CBC, a spokesperson for Shared Health said that creating this centralized wait-list is a top priority for the task force. 

Private clinics

One of B.C.'s tactics was sending patients to private clinics for procedures. The surgeries are still publicly funded and cost nothing to the patient, though they can become costlier for the province.

It's part of a concerted effort to increase surgical capacity across B.C., said Dr. Matthew Chow, president of Doctors of B.C., a voluntary physicians' association.

But Longhurst says that tactic relies on the same workforce to be in two places at once. 

"The same [operating room] nurses that you're hoping to use in a private clinic, many of them are also working in the public system," he said.

If they cut back their hours, "you're not going to be able to increase your capacity in the public hospital."

In announcing details about its task force in early December, the province of Manitoba said it had already invested $8.8 million this year in agreements with both public and private clinics to increase surgical capacity.

An initial report summarizing the progress made to date will be released in the new year, the province said.

Hire extra staff, expand operating room hours

Another way to increase surgical capacity is hiring more staff, allowing operating rooms to expand hours to evenings and weekends. 

But hiring is "becoming increasingly challenging, Canada-wide, as we face staffing shortages," said Dr. Chow.

And it's not just surgical staff that would need to be hired.

Specialized health-care providers like dietitians, physiotherapists and occupational therapists are needed for rehabilitation and good post-surgery outcomes. 

But there is a finite number of health-care workers available to tackle backlogs.

"We don't get to call on this additional pool that's waiting in the wings. It doesn't exist," Longhurst said.

Almost two years into the pandemic, Dr. Chow says that burnout and low morale among health-care workers also make the hiring process more difficult.

In its latest surgical renewal progress report, B.C. said it had hired a total of 1,981 health-care staff since April 2020. 

The progress report doesn't provide details on where workers were hired from, or whether they were new hires or redeployed to address the backlog.

The report does say the number includes over 1,240 nurses, 68 surgeons and 81 anesthesiologists.

Stopping COVID-19 in its tracks

Even with more staff, expanded operating room hours and better waiting list management, clearing backlogs will ultimately rely on the pandemic being under control, Dr. Chow says.

"It all comes down to the spread of COVID-19. You really, really have to get the spread under control to do any of this."

Longhurst agrees, adding that the airborne nature of the virus that causes COVID-19 is not being taken seriously enough.

"I fear that we're going to be doing this surgical backlog game for the next I don't know how long," he said.

The rapidly spreading Omicron coronavirus variant is threatening to increase the backlog even more — not only in Manitoba, but across the country.

"I'm very worried about what it represents for surgical procedures, because the models are suggesting that we're basically going to be cancelling all surgeries in the new year," Longhurst said.

"As we continue to do these waves [of infection], we're going to be constantly dealing with cancelled surgical care."

Longhurst says that while B.C. has largely cleared its backlog for now, it's not sustainable long-term.

Increasing surgical capacity and hiring more staff might work short-term, but efficiency will diminish as staff become burned out or need to isolate due to COVID-19 exposures.

Without a centralized wait-list system, the way surgical patients flow through the health-care system will continue to cause backlogs. 

"In health care, more often than not, these ideas and perceived shortcuts don't result in the improvements that governments think they will," Longhurst said.