ABSTRACT
Purpose: The COVID-19 pandemic burdens non-covid elective surgical patients by reducing service capacity, forcing extreme selection of patients most in need. New tools are urgently required to prioritize operations and optimize the process sustainably. Our study assesses the SWALIS-2020 model ability to prioritize access to surgery during the highest viral outbreak peaks. Methods: A 2020 March - May feasibility-pilot study, tested a software-aided, inter-hospital, multidisciplinary pathway. All specialties patients in the Genoa Departments referred for urgent elective surgery were included in a multidisciplinary pathway adopting a modified Surgical Waiting List InfoSystem (SWALIS) cumulative prioritization method (PAT-2020) based on waiting time and clinical urgency, in three subcategories: A1-15 days (certain rapid disease progression), A2-21 days (probable progression), and A3-30 days (potential progression). We have studied the model applicability and its ability to prioritize patients by monitoring their waiting list and service performance. https://www.isrctn.com/ISRCTN11384058. Results: Following the feasibility study (N=55 patients), 240 referrals were evaluated in 4 weeks without major criticalities (M/F=73/167, Age=68.7 +/- 14.0). Waiting lists were prioritized and monitored. The SWALIS-2020 score (% of waited-against-maximum time) at operation was 88.7 +/- 45.2 at week 1 and then persistently over 100% (efficiency), over a controlled variation (equity), with a difference between A3 (153.29 +/- 103.52) vs. A1 (97.24 +/- 107.93) (p <0.001), and A3 vs. A2 (88.05 +/- 77.51) (p <0.001). 222 patients underwent surgery, without related complications or delayed/failed discharges. Conclusion: The pathway has selected the very few patients with the greatest need, even with +30% capacity weekly modifications, managing active and backlog waiting lists. We are setting up collaborations for multi-center research.
Subject(s)
COVID-19/epidemiology , Elective Surgical Procedures/statistics & numerical data , Health Services Accessibility/organization & administration , Models, Organizational , Pandemics , Waiting Lists , Aged , Appointments and Schedules , Feasibility Studies , Female , Humans , Italy/epidemiology , Male , Middle Aged , Pilot Projects , SARS-CoV-2ABSTRACT
Background: The COVID-19 outbreak is burdening non-COVID elective surgery patients with figures similar to the SARS-Cov-2, by creating an overwhelming demand, increasing waiting times and costs. New tools are urgently needed. Our feasibility-pilot single cohort study assesses a modified Surgical Waiting List InfoSystem (SWALIS-2020) model to prioritize and optimize access to elective surgery throughout and beyond the pandemic (https://www.isrctn.com/ISRCTN11384058). Materials and Methods: In March-May 2020 we tested a software-aided, inter-hospital, multidisciplinary pathway. All specialties elective urgent surgery referrals in the Genoa Metropolitan area have been centralized in the SWALIS-2020 pathway adopting a cumulative linear prioritization method (PAT-2020) by waiting time and clinical urgency categories: A1-15 days (certain rapid disease progression), A2-21 days (probable progression), and A3-30 days (potential progression). Results: Following the feasibility phase (N=55 patients), 240 referrals were prioritized in 4 weeks without major criticalities (M/F=73/167, Age=68.7±14.0), waiting lists monitored, and theatres allocated based on the demand. The SWALIS-2020 score (% of waited-against-maximum time) at operation was 88.7±45.2 at week 1, then persistently over 100% (efficiency), over a controlled variation (equity), with a difference between A3 (153.29±103.52) vs. A1 (97.24±107.93) (p <0.001), and A3 vs. A2 (88.05±77.51) (p <0.001). 222 patients underwent surgery, without related complications or delayed/failed discharges. Conclusions: This is an early pilot study. However the pathway has smoothly selected the very few patients with the greatest need, optimizing access even with +30% capacity modifications weekly, consistently managing active and backlog waiting lists. We are looking for collaboration for further multi-center research to progress through the next pandemic phases. Robotic surgery for Abdominal Cancers: How far can we go?