How to Prioritise and Optimise Access to Elective Surgery in the COVID-19 Pandemic: An Interhospital Alliance Pathway Based on the SWALIS 2020 Model. A Single-Cohort Feasibility & Pilot Study

Background: Surgical capacity is reduced due to COVID-19; and actions are required to optimise access, as the waiting patients’ needs dramatically exceed the available resources. The Italian Liguria Regional Health Trust (ALiSa) commissioned a pathway for all cancer/urgent cases from the metropolitan area of Genoa (840,000 inhabitants). Methods: The 6-week single-cohort feasibility-pilot of a software-aided, inter-hospital, collaborative multidisciplinary pathway covering all specialities in the Genoa Departments of Surgery. It modifies the Surgical Waiting List InfoSystem (SWALIS 2020) prioritisation model based on waiting time and clinical urgency by implicit criteria. We have introduced three new urgent subcategories: A1-15 days (certain rapid disease progression), A2-21 days (probable progression), and A3-30 days (potential progression). Findings: 295 referrals were evaluated in 6 weeks without major criticalities from 12 Surgical Units. Waiting lists were weekly monitored, and theatres allocated based on the existing demand. Their urgency category frequencies differed between week 3 and week 4 (p = 0·031). The SWALIS priority score (% of the waited against maximum time) in the operated patients was 88•7 ± 45•2 at week 1 and then persistently over 100% (efficiency), spread over a controlled variation (equity), with a difference between the A3 (153•29 ± 103•52) vs. A1 (97•24 ± 107•93) (p