An inside look at the ER of Canada’s largest pediatric hospital as RSV escalates
It’s the exhaustion on the parents’ faces that hits you first.
CBC News got exclusive access to the emergency department and ICU at Toronto’s Hospital for Sick Children, Canada’s largest pediatric medical center, as it and other hospitals across the country face what a Dr. has called a “perfect storm” of COVID-19, the flu and respiratory syncytial virus (RSV).
The stress of recent increases isn’t just on families. It is also taking its toll on the staff, who are already exhausted and exhausted from three years of Covid-19. Long waits are creating stress and resentment directed at nurses and others.
“I’ve been a nurse for almost 12 years now and this … has been the hardest year ever,” said Lindsay Stewart Ledger, charge nurse in the emergency department.
Harassment of health care workers in Canada has been on the rise for years. Oh 2021 Paper Canadian Medical Association Journal (CMAJ) calls for action on growing violence. She cited a 2017 survey in which 68 percent of registered practical nurses and personal support workers reported experiencing workplace violence at least once a year.
At the front door of the SickKids emergency department, two security guards stand ready to deal with frustrated parents. Stewart Leger understands why parents are frustrated but feels it’s a reality families have to expect and accept.
“Recognize that just because you’re in line before someone else doesn’t mean you’ll be seen before that child. There can be many reasons why we pull children out. , medical history, seeing something so subtle that we are not happy or concerned about it,” he said.
On a visit to the ER with division chief Dr. Jason Fisher, the rooms are packed and the hallways are filled with coughing and crying babies.
A mother, suffering from fatigue, is trying to buckle her baby into a car seat. Others, in the waiting room, try to distract their children with games and coloring books.
Overflow waiting area
Fisher describes what the hospital has been experiencing for weeks as “unprecedented.”
“It’s really a perfect storm of different factors,” he said.
Demand has been so high for some days that the hospital has set up an overflow waiting area in the cafeteria. Doctors have also taken over the nearby orthopedic clinic to open up more beds for patients.
“This emergency department was designed for 65,999 visits a year. And this year, if we follow the pace, we’ll have over 90,000 visits,” Fisher said.
Figures from the hospital show there were 8,877 visits between October 3 and November 7, a 21 percent increase from the same period three years ago. The average wait time in the emergency department was three times longer than in October 2019, with some patients waiting as long as 12 hours.
For many parents, Fisher said, the hospital is a last resort given drug shortages and lack of access to primary care doctors.
“When I remember this family and talking to them, I had a special overnight shift and they were very apologetic about coming to the emergency department, but they accessed care in three different ways before they came. Tried to get it.”
The ripple effect
The impact of this latest addition is being felt throughout the hospital.
Last week, SickKids announced it was canceling non-urgent surgeries. Staff are being redeployed to the emergency department and pediatric intensive care unit, which is fully loaded with care for sick children.
“We’re in a situation right now where these children are so advanced in breathing difficulties or what we call respiratory failure … that the only way we can provide care for these children with life-threatening illnesses is to Resources have to be diverted elsewhere. And unfortunately those kinds of difficult decisions are required,” said Dr. Steven Schwartz, the hospital’s chief of critical care medicine.
“This is to an extent … our COVID in children.”
In the nursing station adjacent to the ICU, Schwartz meets with team members to discuss how to make more room for children waiting in the emergency department during staff shortages.
“We have a room with six flu patients so we’ve moved patients,” said LeAnn Williams, a registered nurse on the floor. “We have a patient that we hold at Emerge who is on BiPap. [a breathing machine] That needs to come. I have no place for this patient.”
Hospital officials say it feels trapped right now.
“We’re doing our best to get these patients out so we can get others in,” said Jackie Hubbert, executive director of critical care services. “I’m a bit handcuffed to be honest.”
Schwartz responded by telling him that help was coming from different parts of the hospital. But because SickKids and other children’s centers across Canada are overwhelmed with worried parents, there is a risk that a child may not be seen by doctors in time.
“What keeps us up at night is that some child who really needs our care will be stuck somewhere else and unable to get in here,” she said.
As cold, flu, RSV and COVID-19 season intensifies, SickKids doctors and staff hope to soon have pharmacy shelves filled with Tylenol and other medications to help children. But to keep the hospital open to those who need it most, Schwartz said full vaccinations and mask wearing are essential in crowded situations.
“Anything we can do to reduce the spread of these diseases in the community is a help to us, but more importantly, it’s a help to your child.”