Sask. mulling move to more stringent ICU patient triaging, official says

Though triaging of Saskatchewan ICU patients is already happening to some degree in hospitals overburdened by the fourth wave of COVID-19, an official with the Saskatchewan Health Authority (SHA) says decisions about who gets admitted into an ICU could intensify in the days to come.

In the early days of the pandemic, Saskatchewan's health-care system enacted an ethical triaging framework for deciding who would and would not be admitted into an ICU at a time when intensive-care beds are in short supply.

During Saskatchewan's latest COVID-19 news conference on Friday, SHA head of emergency operations Derek Miller said a committee of clinical experts, physicians and ethicists is continually reviewing whether to recommend moving from one stage of the framework to another.

"That is very difficult," he said of any decision to apply the ethical triaging. 

Saskatchewan has been at stage one, in which there are no criteria for excluding anyone from an ICU, "for a number of months now," Miller said — though SHA physicians on Thursday described a situation were some patients who require high-flow oxygen and who would normally be in the ICU are not being placed there because the fourth wave means there's not enough room.

Miller acknowledged surgeries have been delayed because health-care workers have been redeployed to treat COVID-19 patients — many of whom are unvaccinated, according to data shared earlier this week by the government. 

"We have active triage at the bedside right now in terms of who is getting access to which care," Miller said.

In the second of four stages outlined in the SHA's framework, patients with end-stage organ failure, cardiac arrest and "poor prognostic factor" are excluded from ICU care. 

Asked Friday if the SHA has recommended to the province that ICUs move to the second stage of framework, Miller replied, "Where we are right now is considering whether now is the time to consider moving stages."

No plan to move stages actually in place: official

As of Friday, there were 80 COVID-19 patients in Saskatchewan ICUs, along another 37 people in ICUs for other reasons — 117 in total.

Typically, the province's health system only has room for 79 ICU patients in total. The current overload is being handled thanks to the SHA adding more beds by redeploying health care staff normally assigned to other areas, a practice also known as "surging." 

According to a presentation made to SHA physicians on Thursday, a total ICU bed-load of 116 triggers the decision to move patients out of province, something that began happening this week. 

The ethical framework for triaging patient admissions within Saskatchewan ICUs defines stage two as occurring when 125 per cent to 150 per cent of the baseline ICU capacity is occupied.

Marlo Pritchard, the president of the Saskatchewan Public Safety Agency — which has taken over the regular COVID-19 news conferences from the provincial government — said there is no plan to move out of stage one of the ethical framework "as of Monday."

Later during Friday's news conference, Miller added, "We're currently at stage one and monitoring for any need to escalate to stage two."

Read the full Saskatchewan Critical Care Resource Allocation Framework below: