Ontario doctors are proposing a whole new model of outpatient health care to ease the backlog of surgeries and medical procedures caused by the COVID-19 pandemic.
The Ontario Medical Association (OMA) wants the province to begin creating publicly funded Integrated Ambulatory Centres (IACs) in towns and cities across Ontario that would focus on addressing specific surgical procedures in a quick-turnaround setting, that the OMA said would not mix acute patients with non-acute patients, would result in less infections and take less time to treat the patients.
The new concept was spelled out in an online Zoom conference hosted by OMA president Dr. Adam Kassam Wednesday morning, who said the current backlog is beyond anything that can be resolved with conventional approaches.
"The pandemic has created a backlog of more than 21 million patient services, and that includes preventative care cancer screenings such as mammograms and colonoscopies, diagnostic tests, such as MRIs, and CT scans, plus surgeries and other procedures," said Kassam.
He said the new idea of IACs would create free-standing centres that would work with local hospitals to provide OHIP-insured medical services, including surgeries and procedures, on an outpatient basis.
Kassam said this would free up hospital beds and operating rooms, allowing doctors to focus on more complex, acute and emergency patients and procedures and reduce wait times.
"Shifting appropriate day surgeries and procedures to integrated ambulatory centers can improve the experience for patients by reducing wait times, providing shorter recovery times and lower infection rates," said Kassam.
The idea was endorsed by Dr. Jim Wright, a pediatric orthopedic surgeon who is also Chief of the OMA’s Economics, Policy and Research division. Among other things, Dr. Wright was surgeon-in-chief at Toronto's Hospital for Sick Children.
Wright said at the news conference that the most important thing to learn from IACs is that they work well.
"Ambulatory surgery and procedural centers can deliver the same care 20 to 30 per cent more efficiently and probably higher quality," said Wright.
He added it is not only a way to reduce surgical wait times but also a way to reduce burnout among health-care workers. Wright said integration of health services is a key factor in ensuring patients not only get good surgical outcomes, but also that the patients are well looked after before the surgery and after the surgery.
Also, the backlog of surgeries in Ontario right now is not just because of elective surgeries that people just choose to have, Dr. Mary-Anne Aarts, chief of surgery at Toronto's St. Joseph's Health Centre.
She said the backlog involves procedures that people really need to stay healthy.
"And we've just been kind of pushing them down the list as the more urgent case comes along. And that's just how we prioritize in an acute care hospital. It's all that we can do. But all of these patients are suffering emotionally, psychologically. Often, many of them are using opioids on a daily basis, to manage their pain," said Dr. Aarts.
She said that many patients are not able to work, and that just added to their suffering.
"And you know, as a surgeon, it's really hard to see this. It's really hard to not be able to offer patients care who are waiting in need of it. I really welcome this idea of ambulatory surgical centers," said Aarts.
Kassam was asked if locations had been selected for the integrated ambulatory centres. Kassam could not provide specifics but he acknowledged that the OMA is well versed in the health concerns that exist in many underserviced parts of Northern Ontario.
The IAC report that was published Wednesday also recognized there are geographic inequities in getting access to care.
"There are significant regional variations in wait times for certain surgeries and procedures. Less access to care in Northern and rural regions in Ontario can have significant negative impacts on patients’ well-being, and the need to travel greater distances for specialist services is a significant barrier to care for many," said the report.
No costing for the IAC model was spelled out in the formal report, but the document did say that IACs have the potential to reduce the costs of health-care delivery in Ontario and enhance the quality of care by concentrating expertise associated with increased specialization.
"The recent value-for-money audit by Ontario’s auditor general on outpatient surgeries — together with case studies of care in Ontario (e.g., KEI), in other provinces (e.g., Saskatchewan, Alberta, British Columbia) and in other countries—demonstrate that ambulatory centres can perform a range of surgeries and procedures safely and more efficiently than in hospitals can," said the report.
Len Gillis is a Local Journalism Initiative reporter at Sudbury.com. He covers health care in Northern Ontario.