SickKids hospital gradually resumes scheduled surgical procedures amid the surge in respiratory illnesses
Toronto’s SickKids hospital begins the gradual resumption of scheduled surgeries and procedures following a recent months-long surge in patients with respiratory illnesses.
Late last year, SickKids announced it had “no choice but to reduce surgical activity for the time being” in order to “preserve critical care capacity” after its intensive care unit census hit more than 127 per cent capacity for several days and it saw an increase in the number of patients with higher acuity outside of the ICU.
In a Nov. 11 statement, the hospital indicated that more than 50 per cent of its ICU patients were on ventilators.
As a result, six of SickKids’ 16 operating rooms were shut down so staff could be redeployed to overwhelmed critical care and pediatric medicine units and its emergency department.
The Hospital for Sick Children said this move allowed it to “prioritize urgent, emergency and the most time-sensitive surgeries,” including urgent endoscopy services and image-guided therapy.
“We now find ourselves supporting our colleagues virtually to care for paediatric patients who would otherwise receive care at SickKids,” the hospital said at that time.
The decision to resume surgical procedures comes as the downtown hospital sees its “patient census stabilize and return to levels typically seen at this time of year,” SickKids said in a Jan. 15 release.
More than 6,000 patients are currently waiting to have surgery at the Hospital for Sick Children. Families who are waiting for a surgery date will be contacted in the coming months to book their procedures.
Dr. Simon Kelley, the hospital’s associate chief of perioperative services, clinical and ambulatory, said this time has been “some of the most challenging months” in the hospital’s history.
“The extraordinary collaboration within the hospital and vital support of our partners across the system have allowed us to maintain emergent, urgent, and highly time-sensitive surgical services for our patients,” he said in the statement.
“Despite resource constraints and changes to surgical operations, we are proud to have completed over 11,200 surgeries in 2022 – more than 92 per cent of our pre-pandemic volumes.”
In early November, the Ontario Critical Care COVID-19 Command Centre urged hospitals to admit teenage critical care patients to adult intensive care units to help create capacity at children’s hospitals seeing a surge in pediatric ICU patients。
But it still wasn’t enough, the Hospital for Sick Children cancelled surgeries — except for life-saving and the most urgent procedures — in a desperate attempt to bring more staff to its struggling ICUs.
It was a full-out push to free up enough hospital staff and beds during the months-long viral surge that has sent a record number of infants and children to hospital.
Hospital leaders say this “unprecedented response” saved lives. They say it also reveals the precariousness of the province’s pediatric hospital system, long undersized to meet the demands of a growing population.
“The unprecedented response … it prevented a sentinel death event for children,” SickKids president and CEO Dr. Ronald Cohn said.
Ten weeks after the province told children’s hospitals to send teenagers 14 and older to adult ICUs, pressures inside the pediatric system are starting to ease. But conditions remain strained and hospital leaders warn the winter viral season is far from over, and that recovery from the surge will not be easy.
“We are still very, very busy,” says Dr. Steven Schwartz, chief of SickKids’ department of critical care medicine. “We still have plenty of concern. And there’s still plenty of room to fix things in the pediatric health-care system, and particularly in critical care.”
Between early November and the end of December, more than 100 teens received care in adult critical care units, Schwartz says. Before the viral surge, it was not routine for teenagers to be in adult ICUs.
“It was well over 100 by the end of December,” Schwartz says, noting Ontario has about 100 pediatric critical care beds but can add more during surges.
Cohn says the hospital had no choice but to cancel scheduled surgeries in November to create more ICU capacity by adopting a team-based model of nursing. This model of care allows critical care nurses, assisted by redeployed colleagues with little ICU experience, to care for multiple patients at a time instead of a single child.
“This was necessary to ensure no child was left behind,” Cohn says.
As executive director of the hospital’s heart centre, critical care services and Acute Care Transport Services, or ACTS, Jackie Hubbert sees the many stressors — on staff, on families, on hospital operations. She says it takes an extraordinary amount of resources to care for the hospital’s sickest patients, such as those who need to go on a life-support machine, a consideration that sometimes gets lost in bed count and capacity discussions.
“It takes a village to save that patient,” she says. “Never mind the physician and the surgeon, you’re going to need at least five expert nurses … the impact on the team to care for someone so sick is significant.”
In her 23 years in critical care, Frances Barry has experienced periods when the ICU was brimming with patients. But she’s never seen such high numbers of patients, sustained over so many weeks.
“We’re all so stretched,” says Barry, a registered nurse and pediatric ICU charge nurse. “Everybody does their best shift to shift. But when you come in, and there aren’t any options for extra staff or beds, and you know that kids are going to keep coming in, it’s hard.”
“I see people at the end of their shift, worn, worried, concerned, hoping they didn’t miss anything with their patients,” Hubbert says. “I see it in morale. People are finding it harder to garner what they need to get here for their next shift. People are more negative.
“This is an amazing team; they’ve been unbelievably resilient … But people’s reserves are low. They desperately want things to be different.”
Part of the article was reported by the CP24.