A Regional Surgical Partnership Program: Lessons Learned in System Transformation of Pediatric Surgical Care

The province of Ontario has seen significant growth in the waitlists for both pediatric surgery and pediatric endoscopy. Due to long-standing resource constraints exacerbated by the COVID-19 pandemic, the surgical waitlist at a pediatric tertiary hospital in Toronto had risen to over 6,500 patients by April 2023, with 65% beyond nationally validated wait time targets (out-of-window). A regional Surgical and Endoscopy Community Partnerships program was developed with five partner hospital sites to build capacity and decentralize pediatric surgical care by transferring select low-acuity patients, primarily targeting the longest-waiting cases, from the pediatric tertiary hospital waitlists to partner hospitals closer to their homes. Each of the partner hospitals had pre-existing pediatric surgical programs and the necessary infrastructure and staffing to support the referred patients. Between April 2023 and March 2024, this program transitioned more than 650 pediatric cases to partner hospitals, reducing the waitlist by approximately 10%. Early program success has demonstrated that an integrated system-wide approach to the provision of pediatric surgical care is a viable model for future surgical care delivery.