The surging COVID-19 case count in the region has forced local hospitals to temporary close several operating rooms and delay surgeries.
The London Health Sciences Centre (LHSC) cancelled several surgeries this week as it deals with mounting pressure from the pandemic and potential human resources restraints.
When surgeries are cancelled, Dr. Adam Dukelow, LHSC's chief medical officer and head of the Department of Emergency Medicine, says surgery teams look at the acuity of the case and the priority.
“There is a priority system in Ontario that has priority ones, twos, threes and fours. And then our surgical team does a lot of work to look at the list and frankly has to triage who can be postponed and who can't.”
Dukelow says the highest-need patients get their surgeries and the rest are rescheduled as soon as possible.
Priority one surgeries, as defined by Health Quality Ontario, is a patient who could pass away immediately if the surgery is not performed.
Priority two are those where a patient experiences severe or difficult management of symptoms that are likely getting worse.
Dukelow says priority one and two surgeries are not cancelled.
Priority three is a patient experiencing pain or symptoms that do not dramatically impact the quality of life, with some subjectivity.
In priority four the patient may see their condition worsening - medical management may be failing to help the patient’s condition.
Dukelow adds that all surgeries and operations are important and will be rescheduled.
“We don’t take the decision to decrease our operating rooms lightly, it is a challenging decision to make. Those who pick up the phones to make those calls...some of our leadership staff are making those calls and they’re crying, they are so upset they have to do this.”
The reason for the cancellations is the ongoing stress of the pandemic limiting resources says Dukelow.
“That has created a number of issues, one - we do have staff that catch COVID-19 in the community, and that limits human resources...and two…the pandemic decreases our efficiency. In a room we would normally put four people in we are now putting two or three in.”
Dukelow says there are two types of surgeries in general. Ambulatory or outpatient surgery is when a patient does not have to be admitted after an operation, while inpatient surgeries require care and recovery time in hospital after surgery.
“Right now our larger pressure is on our human resources and our beds so it is harder to get our inpatient surgeries complete, so we have pivoted quickly to increase the ambulatory surgeries while reducing some of the surgeries that require inpatient stay.”
Dukelow says once they're able to, they will ramp activity up as much as possible.
On Wednesday, just 14 operating rooms (ORs) were running at LHSC's Victoria Hospital for surgeries that are likely to require admission to the hospital. Similarly, at University Hospital nine ORs were running.
Patients who have a scheduled surgery cancelled are being notified by telephone.
LHSC will continue to adjust surgical volumes each day.