Quality Improvement in Deep Brain Stimulation for Movement Disorders: Pandemic Impact on Specialized Elective Surgery

Area of Science:

• Neurosurgery
• Neurology
• Health Services Research

Background:

• Deep brain stimulation (DBS) is a crucial treatment for Parkinson's disease, tremor, and dystonia.
• The Canada Health Act mandates equitable access to medically necessary services, but 'reasonable access' remains undefined.
• This study investigates access to DBS implantation surgery and identifies key delays in the patient pathway.

Purpose of the Study:

• To assess the time from initial DBS assessment to surgical implantation.
• To identify specific steps within the DBS workup process that cause significant delays.
• To evaluate the impact of the COVID-19 pandemic on DBS surgery timelines.

Main Methods:

• Analysis of DBS implant data from 2016-2023 at the University of Alberta.
• Tracking the time from neurologist's decision to proceed with DBS through surgical implantation.
• Assessing wait times for neurosurgeon, psychiatrist, neuropsychologist, and allied health consultations.

Main Results:

• The total time to DBS surgery increased from 387.76 days pre-COVID-19 to over 839 days during and post-pandemic.
• The most substantial delay was consistently observed between patient consent and the actual DBS implantation surgery, attributed to insufficient operating room availability.
• No improvement in surgical wait times has been noted since the pandemic's conclusion.

Conclusions:

• The time required for DBS implantation has more than doubled since the onset of the COVID-19 pandemic.
• Lack of operating room capacity is the primary bottleneck, significantly extending the time from consent to surgery.
• Current surgical wait times indicate a persistent challenge in providing timely access to DBS, impacting patient care equity.