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‘We’re in big trouble’: Critical-care bed alerts at Toronto General, Toronto Western show a system under strain


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‘We’re in big trouble’: Critical-care bed alerts at Toronto General, Toronto Western show a system under strain

Four days after urging doctors to bypass the emergency department if possible due to overcrowding, Toronto General Hospital issued another internal alert that its ICUs were at capacity and might not have enough staff to keep all critical care beds open.

The critical care bed alert, issued Monday and obtained by the Star, was at least the third such warning at the hospital in October — a worrying sign that one of the busiest critical care centres in the province is struggling to meet demand, even before an expected surge of COVID-19 infections and peak influenza season.

“It’s very concerning. It demonstrates that, at present, there is a limited buffer,” said Dr. Kali Barrett, a critical care physician at University Health Network, which includes Toronto General. “If there is a surge of patients from flu or due to severe COVID-19 infection, it will place considerable strain on the health-care system.”

The Oct. 31 critical care bed alert for Toronto General, which has three ICUs with 81 beds, has since been lifted.

However, in a Tuesday evening statement to the Star, UHN said there is now an equivalent alert at its Toronto Western Hospital, which has 38 ICU beds.

“The pandemic is ongoing, general demand is high and, with human resources limitations, our system is strained,” said Marnie Escaf, clinical vice-president at UHN. “To the best of our ability, our teams continue to find ways to provide care for our patients, even on the toughest days, when the strain is showing in our hospital.”

Monday’s Toronto General alert, meant to inform other areas of the hospital of the situation in an effort to manage capacity, noted that its three critical care units were at their “total bed capacity and/or (had) limited human resources to safely keep all physical critical care beds open and in operation.”

It asked staff to “carefully consider” ICU needs that could only be delivered at Toronto General and that were urgent. It also asked that staff avoid accepting admissions from other hospitals that might require a critical care bed, and avoid sending patients to the emergency department who might need ICU care.

Last Thursday’s internal alert had warned the hospital’s emergency department was “over capacity and/or (had) limited human resources to care for patients in the unit” and urged doctors to bypass the ER or use alternate treatment plans if possible.

“I’m not sure the public truly grasps how strained the health system is right now,” said Barrett. “The front-line workers who are currently caring for a very sick population have survived multiple waves of a pandemic and, like everyone, they have their own personal trauma and loss and they are themselves grieving for what they and everyone has lost through the pandemic.”

For months, hospitals across the province have been struggling to cope with record wait times in ERs and overcrowding on in-patient wards, leading some to postpone surgeries. These challenges are compounded by a staffing crisis — as of March 2022, the provincewide vacancy rate for registered nurses at hospitals was 12.63 per cent, up from just 4.85 per cent in March 2020.

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Hospitals primarily serving rural areas have been forced to close their emergency rooms more than 110 times this year, according to the Star’s latest count, as they deal with staff vacancies and illnesses.

In August, patients admitted to hospital from the ER waited on average 20.7 hours for an in-patient bed, according to data from Ontario Health.

However, a recently leaked report from Ontario Health for August shows that 90 per cent of wait times for an in-patient bed are 33.4 hours or shorter. This means 10 per cent of admitted patients waiting for a bed are languishing in ERs for longer than 33.4 hours, highlighting the worst experience for some patients.

On Tuesday, Hamilton Health Sciences issued an update on overcrowding in its hospitals, noting ongoing staffing shortages were making it difficult for its hospital teams to “accommodate this extraordinary surge in occupancy.”

For weeks, HHS’s McMaster Children’s Hospital has seen record-long waits in its emergency department and its in-patient medical units were at 120 per cent capacity in September, a historic high.

To manage the pressure, the hospital is enacting a number of measures, including reducing the number of scheduled surgeries that require an in-patient bed, and evaluating “the potential transfer” of youth and adolescent patients to other HHS sites “where feasible and medically appropriate.”

“Every effort is made to ensure children get care as close to home as possible and the vast majority of patients requiring care at MCH receive care at MCH,” said the hospital’s president Bruce Squires in an email to the Star.

“We’re in big trouble,” said Dr. Alan Drummond, an emergency physician in Perth and co-chair of public affairs for the Canadian Association of Emergency Physicians, pointing to the expected surge of patients suffering from COVID, influenza and respiratory syncytial virus (RSV) that is going to confront hospitals in the coming months — a future he characterized as a “slow descent into misery and hell.”

“We’ve got governments promoting the idea that people can take off their masks and have a good time. We have now a documented reduction in people getting booster shots for COVID, and we still have hospital capacity that is way beyond safe, and staff morale is low,” he said. “So it’s going to be a coming s—storm in the next couple of months unless we address it.”

Kenyon Wallace is a Toronto-based investigative reporter for the Star. Follow him on Twitter: @KenyonWallace or reach him via email: kwallace@thestar.ca

Megan Ogilvie is a Toronto-based health reporter for the Star. Follow her on Twitter: @megan_ogilvie

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