Moving critically ill patients
A record number of critically ill COVID-19 patients were moved around Ontario hospitals Wednesday — cumulatively covering thousands of kilometres — as the province struggles to juggle patients between a dwindling supply of available hospital beds.
More movement — much more — is coming, as Ontario health officials brace for Toronto-area hospitals to be hit hard by the third wave of COVID, fuelled by more contagious variants.
The relocation of 36 patients from Ontario intensive care units to ICU beds in other regions Wednesday comes as ICU hospital workers fear time is running out to ease demand on medical facilities and staff in the province’s COVID hotspot.
“The system is teetering,” Dr. Michael Warner, head of critical care at Michael Garron Hospital in Toronto, publicly warned.
Warner calls it “Critical Care hopscotch,” as ICU patients from hotspots are moved to other regions, in turn displacing patients from where they are landing.
Dr. Michael Detsky, a critical care doctor at Toronto’s Mount Sinai Hospital, describes it as sharing the burden.
“Everyone is sharing in the caring of these patients,” Detsky said.
“We’re still having a pretty steady inflow of admissions to hospitals and ICUs in the (Greater Toronto Area), and certain hospitals that are getting more admissions than others are trying to offload those patients to other places, so the care can be provided across the system.
“It allows … beds (to) be used by the new people expected the next day,” Detsky said.
On Wednesday afternoon, a multi-patient transfer bus from York Region arrived at the Kingston General Hospital in Kingston, Ont., with two ventilated patients on board. It was the first time the ambulance-bus was used. It can hold up to three critically ill patients.
“Our peer hospitals in Toronto have weathered a substantial challenge for over a year. They are exceeding capacity and are working as hard as they can to get through each day,” said Dr. Renate Ilse, vice-president of patient care at Kingston General. “Because our region was not as affected in the first two waves of the pandemic, we’ve had more time to prepare for wave three and are in a good position to help.”
But while patients from the Toronto area are going to Kingston, “Kingston must offload patients to Brockville and Ottawa,” Warner warned on Twitter, “to make space.” That’s the hopscotch.
The unprecedented moving of patients comes as Ontario’s hospitals have the most patients ever in intensive care units who have tested positive for COVID-19. Of the 2,335 COVID patients in hospital, 790 are being treated in an ICU, with 566 breathing with the use of a ventilator, according to statistics by the Ontario Ministry of Health.
Some of the patient transfers cover a lot of distance.
According to information from Monday, a patient was moved from Credit Valley Hospital in Mississauga to Sault Ste. Marie, 700 kilometres northwest. The same day, a patient from Lakeridge Health in Ajax was transferred to North Bay, more than 300 kilometres due north.
Among the transfers from Wednesday, a patient from Cortellucci Vaughan Hospital just north of Toronto was moved 70 kilometres north to Royal Victoria Regional Health Centre in Barrie, while someone from the Barrie hospital was moved 290 kilometres further north to Sudbury.
Also on Monday, two patients were moved from Toronto’s Humber River Hospital to Stratford, 140 kilometres west, and another was taken 105 kilometres from Oakville Trafalgar Memorial Hospital to Woodstock.
Among the Wednesday transfers, five patients were moved from Etobicoke General Hospital: two went to London, two to St. Catharines, and one to Toronto’s Hospital for Sick Children. Six patients were moved from Brampton Civic Hospital: two went to St. Thomas, two to Guelph, one each to Kitchener and Cambridge.
And on it goes. Toronto patients were also moved to hospitals in Hamilton, Burlington, Brantford, Kingston, Peterborough, Ottawa, and Cornwall.
The patients are being moved by roads and by air, coordinated by Ornge, Ontario’s not-for-profit provider of critical care transport.
During this third wave, Ornge activated a “Surge Response Team” for temporary critical-care land ambulance resources, hooking up with local paramedic services for assistance, said Joshua McNamara, a spokesman for Ornge.
From Jan. 1 to April 20, Ornge arranged to move 1,238 patients, he said.
Almost half of them were this month.
There were 209 patients transported in January; 217 in February; 242 in March; and 570 from April 1 to 21, according to the company. Of those patients, 680 were moved by local paramedic services and 558 by Ornge — 497 by road, 39 by helicopter and 22 by airplanes.