Due to the coronavirus pandemic, hospitals have canceled or deferred elective surgery during COVID-19 spike periods, causing already congested wait times to become so lengthy that many physicians are worried patients will die while they wait.

According to the most recent Canadian Institute for Health Information data, nearly 560,000 fewer surgeries were performed during the first 16 months of the pandemic compared to 2019.

In the past, hospitals attempted to solve their overcrowding problem by building more emergency room beds and new patient wings rather than investigating patient flow.

But Harvard researcher expert Eugene Litvak says the problem is in the scheduling, and he has a solution that is already delivering results in U.S. hospitals and some Ontario hospitals.

Litvak, president of the Massachusetts-based non-profit Institute for Health Care Optimization (IHO), says it all boils down to how hospitals admit patients. 

“I learned that the cause of these patient spikes wasn’t the overcrowded emergency rooms, but hospital operating rooms where surgeries are performed,” he said. “That was an ‘Aha moment’ for me.”

Surgeons typically schedule their procedures early in the week to avoid being called in to check on patients over the weekend.

As a result, he explained that surgical patients fill up more beds earlier in the week, extending emergency room delays in admitting new patients. By midweek, the hospital becomes overcrowded, placing an excessive workload on nurses and support staff.

American medical center’s that have adopted this former Soviet mathematician and systems engineer’s methods claim to have reaped millions of dollars in additional revenue and avoided unnecessary construction costs while reducing medical errors, overtime pay, and ER wait times.

Hospital executives who have hired Litvak describe him as a genius and a pioneer in improving hospital operations management.

The Ebb and Flow

According to Letvik, the graphed pre-pandemic daily number of surgeries at a typical hospital would look like an erratic electrocardiogram with numerous daily peaks and valleys. And most people would assume that unforeseeable health emergencies cause unpredictable ebbs and flow in hospital occupancy.

“But here is the secret: that the common sense and the health-care delivery are not compatible,” he said. “It is easier for me to predict when somebody will break a leg and come to the hospital than when scheduled surgery will take place. And that’s the core of the problem.”

Latvia recommends hospitals need to flatten the troubling peaks and valleys by putting equal demand on the system every day of the week for scheduled surgeries. This would require surgeons to see patients on the weekend.

He hopes that more Canadian hospitals follow Toronto’s University Health Network and consider implementing his method to save healthcare dollars and lives. “Some hospitals don’t call us until they’re going underwater, like a patient calling a priest when ready to depart this world.”

Concept is Not New

At a health policy speech hosted by Alberta Innovates in 2014, Dr. Harvey Fineberg, former president of the National Academy of Medicine, highlighted the virtues of distributing hospital admissions evenly.

“You can work miracles on the flow of patients in terms of resource availability and the emptying of emergency rooms,” Fineberg told his audience. “This is something that can be done without investing a single dollar in capital.”

The cost of clearing COVID backlogs is estimated to be in the billions of dollars.

The University Health Network in Toronto

Before the pandemic, The University Health Network in Toronto, which handles Canada’s most extensive surgical program, implemented Litvak’s method.

According to the medical centre administration, hospitals now identify emergent cases and the resources required to provide the appropriate care, then redistribute the workload throughout the week.

The University Health Network Experience

• Fewer Canceled Surgeries
• To date, approximately 1000 backlogged cases have been cleared
• Five to ten percent increase in capacity
• Operating room staff have a more stable schedule
• Cost savings

U.S. hospitals reported similar results to the Chicago Tribune. According to James Anderson, former president and CEO of Cincinnati Children’s Hospital, IHO assisted in increasing revenues, reducing ER and OR wait times, and achieving significant quality improvements.

“We not only improved patient satisfaction levels, but instead of running around like crazy because of patient overcrowding or sitting doing nothing when few surgeries were planned, our nurses and physicians got home in time for dinner, they made their kids’ soccer games, and life got a lot more orderly,” Anderson recalled.

“There are fewer mistakes and adverse incidents, and the surgeons are happier because fewer of their scheduled surgeries are canceled,” he added.

What We Think

The IHO addresses critical difficulties in most countries’ public healthcare systems, such as cancellations, wait times, staff and patient satisfaction/safety, and dollars.

Litvak’s scheduling strategy appears to deliver on these points. Therefore, health authorities should test-drive the IHO, or a similar approach, the benefits to the exhausted, strained public hospitals could be monumental.

• It is unavoidable to cancel elective surgeries during pandemic peaks. However, once the demand for COVID patient care subsides, hospitals will require a practical solution for managing backlogs and their cost.
• Implementing a new scheduling system is a minimal cost compared to cancellations, overtime pay and building additional infrastructure.
• The Litvak’s system has delivered positive results in Canada and the United States.
• As for surgeons who must work weekends, most nurses and support staff already work alternate weekends. Yet, the IHO approach has delivered more stable staff scheduling. “… our nurses and physicians got home in time for dinner, they made their kids’ soccer games, and life got a lot more orderly,” James Anderson, former hospital president, and CEO.
• And finally, an improvement in patient safety and satisfaction!