Pediatric Surgical Outreach: An Underutilized Resource for Increasing Children's Surgical Capacity in Canada.

Abstract

Background: Wait times for children's hospital-based surgical services are at unprecedented levels. Opportunities to increase most children's hospital-based service capacity are sparse, and community-based services are a potential patient-centered alternative. The aim of this study was to understand the current state of pediatric surgical outreach in Canada as an option to address these challenges.

Methods: An electronic survey was sent to all (n = 18) Canadian children's hospital surgical leaders inquiring about "outreach services" defined as inpatient/outpatient services provided by pediatric surgeons outside of children's hospitals. Descriptive analysis of outreach included facility type/location (by postal code), nature and frequency of service, and participation of other specialties.

Results: 18 survey respondents (100 %) reported that pediatric surgical outreach services were available in 7 out of 10 provinces, but only 8/18 (44 %) of Canadian children's hospitals. Services include: i) inpatient coverage at 2 sites in 2 provinces; ii) outpatient surgery at 6 sites in 3 provinces (median distance 69 km, range 6-1881 km from home children's hospital); and iii) outpatient ambulatory clinics at 19 sites in 4 provinces (median distance 18 km, range 4-1448 km from home children's hospital). Median frequencies of outreach surgical slates and clinics were 1 per week and 1 per month, respectively.

Conclusion: Less than half of Canadian children's hospitals have developed outreach programs as a strategy to increase capacity for children's surgical services. To promote improved surgical care for all Canadian children, efforts targeting expansion of outreach capacity could increase access for geographically remote children.

Type of study: Cross sectional Retrospective Survey.

Level of evidence: Level IV.