Surgeries and procedures to resume gradually

While hospitals must continue to maintain capacity to respond to COVID-19, the Ontario government announced hospitals can begin planning for the gradual resumption of scheduled surgeries and procedures.

“Delaying scheduled surgeries was one of the toughest decisions we had to make as we responded to the growing threat of COVID-19,” said Health Minister Christine Elliott. “However, it was imperative to ensure our readiness to protect the health and wellbeing of Ontarians as we planned for a worst-case scenario. Due to the collective efforts of everyone to stop the spread of this virus, we are now in a position where we can begin to plan for ramping up surgeries.”

As a first step, hospitals will need to assess if there is adequate staffing, equipment and other resources to resume scheduled care. This assessment will be revisited on a weekly basis to reflect changing needs and requirements, including responding to any COVID-19 surges that may occur locally.

Timelines will vary from hospital to hospital and be conditional on approval by regional oversight tables involved with planning and coordinating Ontario’s response to COVID-19.

Premier Doug Ford and Elliott, Deputy Premier and Minister of Health announced the plan Thursday morning.

“We’re taking a responsible and gradual approach to resuming scheduled surgeries, one that will keep our health care system strong, protect our frontline staff and patients, and ensure our hospitals stay prepared for any potential outbreak or surge of COVID-19,” said Premier Ford. “We’re asking each hospital to come up with a plan based on their community’s needs and the trends they’re seeing on the ground. Together, we can get surgeries back on track as soon as possible.”

The framework, A Measured Approach to Planning for Surgeries and Procedures During the COVID-19 Pandemic, contains clear criteria that must be met before hospitals can resume scheduled surgeries, including ensuring that the hospital and its region have the following:
A stable number of COVID-19 cases;
A stable supply of personal protective equipment;
A stable supply of medications;
An adequate capacity of inpatient and intensive care unit beds;
An adequate capacity of health human resources; and
The availability of post-acute care outside the hospital that would be required to support patients after discharge.

The framework also sets out the criteria for prioritizing surgeries such as:

A patient’s condition;
The type of procedure a patient requires and whether options for non-operative treatments exist;
The associated risks of delaying a patient’s surgery; and
The resources required in terms of personal protective equipment, medications, intensive care unit beds, and other care requirements needed after an operation.

Hospitals are also encouraged to look for opportunities to improve care delivery for scheduled surgical and procedural care. This could include using services that reduce patient time spent in acute care settings, the use of virtual care, care in the community, post-op remote monitoring programs, outpatient care, and the use of e-consults services, virtual medical assessments and triaging.

Patients requiring non-emergency care can access physician care through telephone and video services. Patients can contact their physician for details or Telehealth Ontario if they do not have a family doctor.
Emergent or urgent surgery and procedures have been continuing on a case-by-case basis, weighing the risk of further delay of treatment against the risk of proceeding and the risk of virus transmission.