Ontario hospitals lack capacity for waves of critically ill patients, report says

With the increase in COVID-19 cases in Ontario and ICU cases beginning to rise, a new report warns that the province’s intensive care system is more strained than in previous pandemic waves and does not have the capacity to cope with waves of critically ill patients.

The report, released Tuesday by the Ontario COVID-19 Scientific Advisory Board, points to the ongoing stressors facing intensive care units, including staff shortages and burnout among healthcare workers, which have intensified during the pandemic.

It also establishes that hospitals, which are rushing to catch up with delays in diagnosis and surgical operations related to the pandemic, have less capacity to reallocate resources and healthcare workers to ICUs, a key strategy used by hospitals. of the third wave to serve an unprecedented number of patients with serious illnesses. sick COVID patients.

The report’s authors are calling for public health measures to continue through the winter to help slow the spread of COVID cases, warning that the hospital system may not be able to scale up as it did in previous waves.

“This is not the time to relax public health measures,” said Dr. Kali Barrett, an intensive care physician with the University of Toronto Health Network and lead author of the new scientific table report. “Knowing that the system is a little bit more fragile right now means we have to be more careful, methodical and proactive as we move forward in the weeks ahead.”

During the third wave, some Ontario hospitals, notably those in Toronto, Peel and the York region, came close to being overwhelmed with COVID patients. The report describes how extraordinary measures, including massive patient transfers, postponement of scheduled surgeries, and redeployment of hospital staff, enabled the province to expand the ICU’s capacity to meet demand.

Between January 5, 2021 and July 4, the COVID-19 Intensive Care Command Table of the province coordinated the transfer of 976 patients from the ICU. In May, the number of adult ICU patients with a ventilator “was 180 percent of the pre-pandemic historical average,” the report says.

“We were able to accommodate an unprecedented number of patients requiring invasive mechanical ventilation who were incredibly ill,” said Barrett, former assistant scientific director of the Ontario Scientific Advisory Board. (Barrett resigned from his position earlier this year to focus on his academic work.)

But now, in the fourth wave, staff shortages and burnout among healthcare workers mean the province’s critical care system is less able to respond to waves of new patients, he said.

According to the report, the average nursing vacancy rate in adult ICUs increased from 5.8 percent in 2017-18 to nine percent between January and August 2020, an increase that does not account for the addition of nursing beds. recently funded critical care in the pandemic. . And while more recent data on staffing is not yet available, Barrett said anecdotal reports of medical leads in ICUs suggest the crisis has worsened.

“Nurses have been the hardest hit,” he said. “They are exhausted, they have experienced unprecedented moral distress and burnout is a real problem. People are reaching their limits … and they are leaving the workforce. ”

During a news conference Monday outlining the province’s response to the new Omicron variant, Ontario Medical Director Dr. Kieran Moore said there is currently sufficient hospital capacity to treat COVID cases. .

Although the average daily number of patients in Ontario ICUs in October was about the same as in the years leading up to the pandemic, the number of very ill patients was higher, and more patients required mechanical ventilation compared to previous years, Barrett said. .

“It is important for the public to recognize that this is a system that is not as resilient now as it was a year ago. There is not the same kind of capacity to meet the demands that we have now. “


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