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Cardiac, Vascular and Stroke Activity Reporting and Backlog Modelling

In response to COVID-19, CorHealth Ontario (CorHealth) recognized the need to quantify and monitor the impact of COVID-19 on cardiac, vascular and stroke hospital activity in a timely manner. This monitoring enables hospitals and system planners to compare the effect of COVID-19 across providers and regions, alert CorHealth and the Ministry of Health (MOH) of reduced access to care that can potentially lead to patient morbidity and mortality and informs backlog and capacity planning.

To support more frequent and current activity reporting, CorHealth leveraged various data sources to obtain more timely data on vascular and stroke hospital activity. These data sources include the CorHealth Cardiac Regisitry, Access to Care-Wait Time Information System (ATC-WTIS), Canadian Triage Acuity Scale (eCTAS) and Integrated Decision Support Business Intelligence Tool (IDS Hamilton).

The first regular report of cardiac procedure activity, based on CorHealth Cardiac Registry data, was shared with the Cardiac COVID-19 Stakeholder Forum on March 26, 2020, and will continue to be updated and distributed on at minimum a biweekly basis. The first regular report of scheduled vascular procedure activity, based on ATC-WTIS data, was shared with the Vascular COVID-19 Stakeholder Forum on April 15, 2020 , and will continue to be updated and distributed on a biweekly basis. CorHealth intends to integrate all data sources and build comprehensive and coordinated reporting on vascular, cardiac and stroke activity.

Backlog Modelling

In response to COVID-19, CorHealth recognized the need to quantify the expected waitlist backlog of cardiac and vascular scheduled procedures and associated resources required to clear the backlog.

Backlog modelling aims to answer the following questions:

  • At a provincial and regional level, what is the size of the expected backlog, given post-COVID slowdowns across the province?
  • What potential capacity ramp-up scenarios should be considered?
  • Under the identified scenarios, approximately what are the resources requirements (OR days, ward and ICU beds, and personal protective equipment)?
  • How long will it take to clear the backlog?
  • What are potential consequences of increased wait times, and what mitigation strategies should be considered?

Modelling the expected backlog is a proactive and system-level approach that helps stakeholders to understand the implications of current and future levels of reduced activity and access to care, on future demand for services. This enables the system to react, plan, and act accordingly to reduce harm associated with increased wait times and supports a consistent and evidence-based decision-making to optimize hospital resource use. It also helps ensure that capacity planning and resource allocations balance pandemic needs with the needs of the vascular patient population.

CorHealth has quantified the expected backlog of scheduled vascular procedures to the end of calendar year 2020 using a differential of this year’s volumes against last year’s volumes and anticipated capacity for the rest of the year. Based on these backlog estimates, provincial and regional resources required to clear the backlog were estimated, and time required to fully clear the backlog to pre-pandemic levels were estimated using a few different scenarios.

CorHealth is now working with the COVID-19 Resource Estimator (CORE) modelling team to model mortality and urgent admissions on the vascular wait list, starting with aneurysm procedures. We are also beginning to consult with vascular stakeholders to identify and quantify the effect of strategies to shift towards less resource intensive modes of care delivery to improve throughput for clearing the backlog more quickly.

Similarly, the cardiac wait list in Ontario has decreased over the course of the COVID-19 pandemic even during a period of decreased procedural activity. This change in the waitlist was accompanied by an observed drop in referrals, most likely because of ramped down physician and clinic activity in the community. CorHealth, in collaboration with Dr. Harindra Wijeysundera, has used CorHealth Cardiac Registry data to estimate the magnitude of the true backlog for cardiac services in the province. Using historical referral data, the size of the expected wait list for cardiac services was estimated and a few scenarios were created to demonstrate how long it would take and how much of an increase in activity would be required to reduce the waitlist to a pre-pandemic state. This information was presented to the Cardiac COVID-19 Stakeholder Forum on June 4, 2020.