The Western Cape Surgical Recovery Project: experience at Groote Schuur Hospital

Background Data from six Western Cape secondary-level hospitals have shown that during the first wave of the COVID-19 pandemic (which lasted from May to July of 2020), total surgeries decreased by 44%, and elective surgeries by 74%, due to secondment of nursing, anaesthetic and surgical staff to COVID high-care and intensive-care services. At Groote Schuur Hospital, the loss of surgical output over the two years of the pandemic-related surgical service de-escalation (2020-2021) was estimated at 10 000 cases, with 6 000 patients with progressive disease waiting for elective surgical care. Methods In early May 2022, a Surgical Recovery Project was initiated; funding from the Western Cape Department of Health, and donations from the Gift of the Givers Foundation, private individuals, businesses, and other non-governmental organisations were used to build, staff, and equip a Day-Case Surgery Suite. Results By the Project midway point (end October 2022), a total of 800 extra cases had been completed, and the Project is currently on track to exceed the target of 1 500 cases in a calendar year by at least 10%. The largest number of procedures done were eye cases (n = 191), followed by cases involving surgery to the integumentary system (n = 141), and musculoskeletal system cases (n = 123). There were a total of 30 patient cancellations. While the Project expectedly had poorer on-time-start statistics in the first quarter of operation (range 0.0 - 6.9%), the percentage of on-time-start statistics improved markedly over the second quarter (range 43.3 - 56.5%). World Health Organization checklists were completed for 85.1% of operations performed at the Day-Case Surgery Suite, and no adverse incidents or mortalities were recorded at the Unit. Conclusions This project demonstrates that the volume of services provided in the public sector can be escalated with the use of external funding of capital for human resources, equipment and consumables. However, these services become truly effective when there is sufficient multi-disciplinary planning, alignment and support, at operational, strategic and executive levels of healthcare facilities.