Systematic implementation and impact evaluation of data-driven cardiac surgery triaging tools to optimize operational efficiency and enhance patient outcomes during the COVID-19 pandemic and beyond

The COVID-19 pandemic has precipitated a health care crisis that disrupted the care of patients with cardiovascular and other health conditions. Non-emergent procedures were deferred amidst this crisis to create capacity for COVID-19, creating surgical backlogs around the globe. This growing surgical backlog of patients with advanced cardiac disease creates a dilemma for clinicians and administrators, as these patients require monitoring in the intensive care unit (ICU) after surgery and may potentially compete with the resource needs of those with severe COVID-19 infection. On the other hand, prolonged wait times are associated with worsening disease severity, unplanned hospitalization and death. In response to this challenge, our group developed the CardiOttawa Length of Stay (LOS) and Waitlist Scores as evidenced-based decision support tools to prioritize high-risk patients needing definitive surgery while preserving ICU and hospital capacity, improving patient outcomes and reducing health care resource consumption. The CardiOttawa is founded on high quality, population-based data and has been used daily at the University of Ottawa Heart Institute since April 2020 to triage all cardiac surgery referrals with a high degree of clinical success. The main objectives of our proposal are to systematically implement the CardiOttawa throughout Alberta and Ontario, and to evaluate clinical impact and the success of the implementation. We have partnered with clinicians and key policymakers and have developed a method for seamless integration at the provincial level. The care and outcomes of all patients requiring ICU resources may be substantially improved if clinical judgment is supported by objective quantification in the planning of care. The CardiOttawa will augment the clinician's ability to safely clear the surgical backlog and more efficiently allocate resources during the COVID-19 period and beyond.