Innovating the Future of Surgery

Women’s College Hospital is the hospital to keep people out of hospital. Guided by the mantra of right care, in the right place, at the right time, teams across the organization are rethinking models of care to not only produce better outcomes, but also help alleviate some of the pressures on the healthcare system such as access and wait times. For the department of surgery, this has meant leveraging research to accelerate virtual care and rethinking care pathways.

“Prior to COVID-19, our department was already a strong proponent of virtual care. We have since accelerated this capability and redesigned the pre- and post-operative experience, producing greater efficiencies and reducing wait times at a critical juncture for our patients,” said Dr David Urbach, the head of the Department of Surgery and the interim vice-president and lead medical executive of Women’s College Hospital.

Today, many Women’s surgical patients only enter the hospital on the day of their surgery. All pre- admission processes are entirely virtual, and progress has been made on creating a self-scheduling portal, producing a more efficient administrative process. Online education materials have been developed, and as patients recover at home following surgery, they are monitored virtually.

To support the adoption of virtual, the Women’s Virtual Care Lab was launched this past spring. Based at Women’s and led by Dr. Urbach and Dr. Simone Vigod, head of the Department of Psychiatry and senior scientist, the lab produces and tests digital health tools and virtual models of care in a real-world environment, maximizing their potential to benefit the health of Canadians, and communities globally.

“The work conducted and tested in the lab will enable our surgical team to accelerate virtual care and produce disruptive change within an ambulatory setting, allowing us to better address common and often ingrained health system issues,” Urbach said.

Funded by the Canadian Foundation for Innovation, this unique “living laboratory” is the first to be implemented at a Canadian academic health sciences centre. The lab is focused on the mental health of vulnerable populations, surgery, healthy aging and the coordination of primary and specialty care It includes a “research command centre” for research staff and trainees, a “sim lab” for simulations and training, and a “live lab” where tools and models of care will be integrated into the electronic health record system for testing.

Progress is also being made to dismantle decades- old practices and address system-wide challenges.

In collaboration with three other hospitals – Unity Health, Sinai Health System and University Health Network – Women’s has established a centralized referral model for anorectal surgery Instead of referrals to individual physicians, patients are entered into a single common queue and referrals are reviewed and triaged based on acuity and priority Individuals are then assigned to the next available surgeon from the multi-hospital team.

This single-front door approach is not only more effective, it’s more equitable. “It is not unusual to see two similar patients in need of the same operation in the same city experience radically different wait times simply because of who they were referred to,” said Urbach. “We can address this issue through improved cooperation and by using a single-entry model.”