Falling Through the Cracks - Evaluating the Role of non-Acute ‘Surgical Liaison’ Personnel during COVID-19 – A Narrative Review

Abstract Background In March 2020, in response to the Coronavirus Disease 2019 (COVID-19) pandemic, the New Zealand (NZ) Government instituted a four-level alert system, which resulted in the rapid dissolution of non-urgent surgical services to minimise occupational exposure to both patients and staff, with the primary health sector bearing most of the diverted caseload. Consequently, the study authors sought to collate information around the establishment of a supportive non-acute surgical liaison role, in a public hospital surgical department, with an interest in establishing this role in NZ . Methods The narrative review conducted systematically in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Databases searched included Pubmed, MEDLINE, Embase and Cochrane Controlled Register of Trials (CCRT). A deductive analysis was applied utilising a Demand Management Model developed by the Institute for Innovation and Improvement (i3) at Waitematā District Health Board. All included studies were rated using the Oxford Centre for Evidence-Based Medicine (CEBM) – Levels of Evidence tool. Results Collation of 19 studies resulted in 3 key findings: firstly, that a surgical liaison could be utilised at the primary care to specialist interface to improve communication and workflow between services. Secondly, a liaison could be utilised directly communicating with patients as a means of increasing engagement and self-management. Finally, this service can be offered through multiple modalities including a non-contact telehealth service. Conclusion Evidence of non-acute surgical liaisons both internationally and specifically within NZ has been collated to provide evidence for its application.