B.C. plans ‘ambitious’ fix of surgical wait-list backlog while still fighting COVID-19

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B.C.'s hospitals have experienced an unusual stillness in recent weeks, beds emptied out for the surge in COVID-19 cases that have not come.

Before the pandemic, the province was struggling to keep up with demand for surgeries – and losing the fight. Over the past three years, British Columbia has increased access to surgery by about 18,000 procedures annually. But the wait-lists continued to grow.

Early in March, 93,000 B.C. patients were waiting for elective – that is, non-urgent – surgery.

Then, the province made the decision in mid-March to cancel elective surgeries, to ensure there would be hospital capacity for patients with COVID-19.

That decision meant 30,000 surgeries have been postponed. And another 24,000 people likely would have been added to the queue, but testing such as mammography has been curtailed as well. Now the wait-lists are getting to the point where non-urgent cases will start to become urgent.

This week, Health Minister Adrian Dix announced his plan to catch up on those COVID-delayed surgeries, with operating rooms reopening next week.

He called it ambitious, and it is.

What Mr. Dix is proposing is to not only deal with the COVID backlog, but to try to fix these intractable problems, even as the COVID-19 crisis remains alive.

“Our surgery renewal plan beginning this month is going to be a massive renewal, it is a hugely ambitious plan that will keep up with new demands for new surgery and clear the backlog created by COVID-19 over the next 17 to 24 months,” he told a news conference.

The province intends to “minimize productivity loss” by being more efficient, to hire hundreds of new nurses and other health care workers, to expand the hours that operating rooms are running, and to tap private clinics to take on more surgeries.

The quest to find efficiencies in B.C.'s health care system is as old as the hills. So is the battle to reduce surgery wait-lists.

The organization representing doctors proposed changes in 2011 to address wait-lists. “Health authorities and hospitals should consistently re-examine how seasonal [operating room] closures can be shortened. Currently unused or underutilized operating rooms should also be examined as options for increasing access and efficiency," the report for Doctors of BC recommended.

Mr. Dix is now calling on surgeons, anesthetists, nurses and cleaning staff to agree to run operating rooms on weekends, and evenings, and to forego summer holidays. Not just for a few months, but for the foreseeable future.

Another part of this new strategy was proposed in a discussion paper from the Ministry of Health in 2015. That planning document said the province’s surgical system was not functioning properly, and recommended an effort to recruit and retain engaged, skilled health care providers to tackle the backlog of cases.

Now, B.C. is going to offer full-time, permanent jobs to all the nurses it can find. The class of 2020 – the 1,500 nurses who graduate this year – will be offered permanent, full-time work, along with part-timers and those who came of retirement to help with the COVID crisis. Training for 400 operating-room nurses will be a priority.

Recruitment won’t be limited to nurses. Mr. Dix said B.C. will add $250-million to its health budget to deal with the surgical backlog, and a large part of that will be for health care staff.

One area that has long been a challenge is recruitment of professionals in anesthesia.

“I think it’s fair to say that over the past decades, sometimes the relationships between health authorities and anesthetists and anesthesiologists have been challenging. But we’re making progress with that, and we need to recruit there as well," Mr. Dix said.

If anesthetists cannot meet the coming demand, Mr. Dix said he’s ready to look at training other health practitioners who can. (That idea, too, was floated in 2015, when the Ministry of Health proposed the use of registered nurses to administer anesthesia.)

Another recycled idea is the use of private health clinics to help clear the backlog of day surgeries. The New Democratic Party, while in opposition, was critical when the Liberal government of the day expanded reliance on private clinics, but Mr. Dix said he wants to use all the capacity they can offer – so long as they don’t extra-bill patients. By May 31, all private contracted facilities are expected to be working at maximum available capacity.

It is perhaps optimistic to think that the province can now create change where it couldn’t before. But there is a unique opportunity to get all the various players on board.

“I think that the plan has to be ambitious, to deal with the number of patients and the burden they’ve had in waiting even longer than they usually wait for their treatment," said Dr. Sam Bugis, vice-president of physician affairs for Doctors of BC, the organization representing physicians.

Dr. Bugis is a surgeon, and after weeks of staring at half-empty operating lists, his colleagues are eager to get back to work. “They’re anxious to get started back looking after their own patients,” he said. "It is going to be challenging, but I think it’s something we can tackle.”

The pandemic has created stress and hardship for patients and health care workers alike, but Dr. Bugis said there is something good happening right now.

“One thing that’s happened in response to the crisis is that the front-line clinicians in various disciplines have realized that they actually can work pretty well together, and can accomplish things in a pretty short time that in the past we might have thought took a really long time,” he said.

If there ever was a moment to push an agenda for change, this is it.

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