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Canada Doctors call for help as hospitals battle surgical backlogs, staffing shortages

12:32  04 december  2021
12:32  04 december  2021 Source:   cbc.ca

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Cheryl Sword often has to stop and rest when she's out with her husband and son. She's been waiting almost two years for two ovarian cysts to be removed. Hundreds of thousands of patients have seen surgical delays due to the pandemic and it will take time and money to clear that backlog. © Submitted by Cheryl Sword Cheryl Sword often has to stop and rest when she's out with her husband and son. She's been waiting almost two years for two ovarian cysts to be removed. Hundreds of thousands of patients have seen surgical delays due to the pandemic and it will take time and money to clear that backlog.

Cheryl Sword does as many activities as she can with her husband and 11-year-old son, until she has to stop and rest.

"My abdominal pain and pressure stops me in my tracks," Sword, 36, who lives in Sherwood Park, Alta., told CBC News.

She was supposed to have two ovarian cysts, one on each side, removed in early 2020. But then the COVID-19 pandemic hit and " the world shut down."

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Her doctor assured her that ovarian cysts are quite common and it would be fine to delay the surgery.

But as time dragged on for more than a year, the cysts got bigger — and so did the pain.

Finally, her surgery was rescheduled for September 2021. Sword notified her daycare clients so they could make alternate child-care arrangements during what was expected to be a long recovery.

But then, Alberta was hit by a devastating fourth wave — and as hospital beds filled with COVID-19 patients, her surgery was cancelled yet again.

"I went into the bathroom, got in the shower, and sat on the floor and cried," she said.

Sword is one of hundreds of thousands of people across the country whose surgical and diagnostic procedures have been delayed, the Canadian Medical Association says.

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A recent report, commissioned by the CMA from consulting firm Deloitte, estimates that there's currently a backlog of 327,800 procedures — and that it will take at least $1.3 billion in additional funding "to return wait-times to their pre-pandemic levels."

"This number may be even higher when additional procedures and the cancellation of non-urgent surgeries in several provinces during the fourth wave are factored in," the report said.

Getting worse, not better

Although hospitals prioritized life-saving and urgent procedures, there are consequences for those patients, like Sword, who didn't meet those criteria, said Dr. Katharine Smart, a pediatrician and president of the Canadian Medical Association.

"There's no question, you know, when services, imaging, testing, biopsies, surgeries are delayed, many people's problems get worse, not better," Smart said.

"So instead of having perhaps a problem that would have had a simple solution or maybe required a non-invasive operation, now you're dealing with a problem that's much more significant for the patient."

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The CMA first called for urgent government funding to deal with ballooning waiting lists back in October 2020, warning that the problem would get worse without immediate action.

"The predictions we made in October 2020 are coming true. The problem has gotten worse, not better," Smart said.

In its campaign platform, the federal Liberal party promised to "immediately invest" $6 billion in new funds "to support the elimination of health system wait-lists."

It also promised to "negotiate agreements with every province and territory to ensure that Canadians who are waiting for care get the treatment they need as quickly as possible."

But that specific funding hasn't materialized — and those agreements don't appear to be in place, Smart said.

"We're still seeing our levels of government really struggling to collaborate to solve the system's issues in front of us."

CBC News asked both Prime Minister Justin Trudeau's office and the office of federal Health Minister Jean-Yves Duclos about the status of that $6-billion pledge, but their press secretaries did not provide a response by deadline.

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In an emailed statement, a spokesperson for the Public Health Agency of Canada did not address the specific campaign pledge, but pointed to more than $40 billion per year in health transfers to the provinces and territories, and said the federal government had also provided an additional $19.1 billion "in support for provincial and territorial health care systems in 2020-21."

"These investments will help health systems to provide Canadians the procedures and treatments they need to stay healthy and clear through the backlog of delayed procedures," the statement said.

The provinces are responsible for health-care delivery, and several have said they're working on the backlog issue. Manitoba is set to announce a backlog task force next week. Ontario has rolled out some backlog funding to hospitals — but in a statement, its health ministry said some of that will be given retroactively.

"Many of the funding streams for surgical recovery, including the $216 million for hospitals to extend operating room hours into evenings and weekends and perform up to 67,000 additional surgeries, are based on hospitals being reimbursed for the level of surgical output they can achieve," said  Anna Miller, a spokesperson for Ontario's Ministry of Health.

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"As such, exact funding amounts will be known only close to year-end when the hospitals report how many actual surgeries have been completed."

'Biggest challenge' is staffing

The chief of surgery at one of Canada's largest hospitals, University Health Network in Toronto, told CBC News that they are "steadily catching up" on backlogged procedures.

Over the past few months, said Dr. Shaf Keshavjee, staff have done more than 1,000 procedures on patients whose procedures had been delayed.

They've done it, he said, by renovating and opening old operating rooms that weren't being used, extending surgical hours during the week and doing procedures on Saturdays.

"The downside of it has been that people are tired and we're short [of] nurses, as everybody is," Keshavjee said. "That's been our biggest challenge."

A debilitating staff shortage is challenging hospitals across Canada, Smart said.

"We really need to be looking at the human health resource crisis and addressing the burnout that's impacting our health-care professionals and planning better for the future," she said.

"We're really, really stretching people beyond their limits to provide care."

Some may argue that more funding can't solve the staffing shortage, Keshavjee said, but he disagrees.

Paying staff the same amount even though they're working much harder makes no sense, he said. Funding to compensate existing staff would go a long way — and more money could mean more investment in recruitment.

At the current rate they're working, University Health Network's surgical backlog alone won't be cleared until March of 2023, Keshavjee said.

Hospitals across the country are grappling with the same reality, including Sword's home province of Alberta.

In early November, the number of backlogged surgeries there reached 15,000 — and health minister Jason Copping said the province didn't have "a clear timeline" on when procedures would resume.

Copping's press secretary didn't respond to CBC's emails requesting an update on the current backlog numbers and whether there was a plan to address the problem.

But Sword's turn to get off the wait-list may finally be coming — with surgery now scheduled for Jan. 13.

Still, she worries about the timing right after Christmas when people will be gathering.

"I'm praying that there's not another COVID wave that happens at that time."

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