As ICU admissions continue to soar in Ontario, critical care doctors and nurses are warning that the province’s plan to add hundreds of new critical care beds alone will not improve the situation they’re currently facing in this deadly third wave of the pandemic. Staff say rising ICU admissions are pushing the system to the brink — a system they say was already stretched thin before COVID-19 hit.
Health Minister Christine Elliott said on Monday the province is taking steps to create more capacity in hospitals by redeploying staff, postponing elective surgeries and transferring patients when she was asked about the alarming increase in ICU admissions in Ontario because of COVID-19 cases.
“By the end of this week we anticipate creating 350 net new spots,” said Elliott. She said the plan is to ultimately free up between 700 and 1,000 beds.
“We are creating capacity and we are making sure that every Ontarian who needs an intensive care bed will get one.”
But medical staff who work in ICU units say each new bed requires a host of resources — including specialized trained staff — that simply aren’t available quickly.
What it takes to run an ICU bed
“At bare minimum, you have to have the physical space,” said Dr. Michael Detsky, an ICU physician at Sinai Health System in Toronto.
“You have to have the physical equipment … so the IV pumps, the ventilators, the dialysis machines, the monitors, all of that stuff has to be available in real time for the patients.”
In addition to space and equipment, Detsky said each bed requires is a network of support staff, including a respiratory therapist, physiotherapist, pharmacist and social worker. That’s in addition to specially trained nurses, who he says are crucial.
“It’s not like there’s this abundance of clinicians who are available to service the existing beds we have, let alone the ‘expanded thousand beds’ that are coming,” he said.
“I get the sense in talking to colleagues at my own hospital and other hospitals that this just feels like there just aren’t enough bodies to look after the patients that you’re anticipating coming to the door.”
Not enough trained nurses
A shortage of critical care nurses is a problem that Birgit Umaigba said existed before the pandemic is now exacerbated by it.
Umaigba, a Toronto-based nurse who specializes in critical care and emergency medicine, says the most critical patients should each have a dedicated nurse.
“You walk in sometimes with three, four, five, six, seven, eight, nine — 10 nurses short,” said Umaigba.
“Having to juggle two patients that are really sick on ventilators is a safety issue … And in those kinds of cases, mistakes are bound to happen.”
Denise Morris, nurse manager in the medical surgical intensive care unit at Toronto General Hospital, watched the number of beds in her her unit increase to 44 from 30 last year.
“You want to have those beds open. But trying to provide adequate staffing and safe staffing is challenging, to say the least,” she said.
“The number of beds is growing faster than the human resource pool that we have. We’re having to rethink how we provide care. And can we do it in a team-based model with the help of additional colleagues from other departments.”
While the province says it’s redeploying staff —including nurses — from other hospitals in areas that aren’t as hard hit to step in and help ICUs in hotspots, some people working in health care pointed out they don’t always have specific training.
“In dealing with certain areas that are more acute than others, you might have nurses that don’t really have the expertise that possibly the staff of those units have,” said Matt Patterson, a Toronto-based nurse who spent nine of his 17-year career in critical care.
Less staff, and those remaining are fatigued
Hospitals are dealing with a shortage of specialized ICU staff, and the ones they have are burned out and exhausted after more than 12 months of working through COVID-19.
Dr. Shelly Dev, intensive care physician at Sunnybrook Health Sciences Centre in Toronto, says ICU staff are being stretched thin.
“We can line up all of the beds in the world, but if you don’t have someone who is healthy, capable, able to help you and provide the care to you when you are there in that bed, the bed doesn’t matter, she said.
“They are physically broken by how hard they’re working.”
Dev said health care staff want to do their best during these chaotic times, but sometimes they’re just not capable of that.
“The worry among all of us workers is that our ability to provide that kind of top-of-the-line care — that we’re so proud to provide in our health-care system — is waning,” she said.
The balancing act
CBC News asked the Ministry of Health why the province is adding more beds without the necessary resources to accompany them, but it didn’t answer the question in a written response.
The ministry also didn’t respond to questions about what it’s doing to recruit more critical care nurses and doctors or whether it is looking for help from other provinces.
“Last week, the province issued two emergency orders to support the redeployment of health-care professionals and other workers to hospitals,” the statement reads.
“In addition, we are providing hospitals with the flexibility to transfer patients to alternate hospital sites in situations where a hospital’s resources are at significant and immediate risk of becoming overwhelmed.”
When asked about what steps the College of Physicians and Surgeons of Ontario (CPSO) and the College of Nurses of Ontario (CNO) are taking to help meet the demands in Ontario’s ICUs — including the registration of out-of-province physicians — both regulatory bodies said they’re expediting paperwork to support the health-care system and have been doing so for the past year.
For those working in Ontario’s ICUs, there is anxiety about the weeks ahead, and the balancing act of managing beds with limited resources. Even so, Morris says the dedication of the ICU staff at Toronto General Hospital is unwavering.
“it’s been very stressful and quite frankly, scary,” she said.
“But staff are committed — they’re committed to their patients and they show up every day.”
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