Inside an Ottawa children's hospital battling against rising RSV, COVID-19, flu cases
‘Historic’ demand comes as health system struggles with staffing challenges
A surge in respiratory illnesses in children. Shortages in medication for kids. Add the start of cold and flu season, plus COVID-19, and it's a "potpourri of problems" that comes at a time when the health-care system has been struggling with staffing challenges, says the president of an Ottawa children's hospital.
"The current situation has so many ingredients … that are converging on a system, a children's health system that was too small already heading into the pandemic," Alex Munter, CEO of CHEO, formerly Children's Hospital of Eastern Ontario, told White Coat, Black Art host Dr. Brian Goldman.
"It's contributing to this historic never-before-seen — in nearly 50 years that CHEO has been open — volume of demand."
This demand is stretching an already overburdened system, says Munter. He's pleading for the community to wear masks and get vaccinated for COVID and flu to help reduce the spread of illness and the number of sick kids.
"It can help make sure that CHEO is able to respond to the pressures that we see."
Munter spoke to Goldman about the challenges facing CHEO and other children's hospitals across the country. Here is part of their conversation.
How busy is it at CHEO right now as it deals with RSV, COVID, and increasingly, the flu?
So [on Sunday], 250 visits to our emergency department. Just put that in context. It's an emergency department that was built for 150 kids. At midnight, we had 10 children in the emergency department that needed a bed, but there was no bed for them.
Our occupancy in our inpatient medicine service is 183 per cent and our occupancy in intensive care is 186 per cent. And so we're opening a second ICU … in the surgical day unit and reallocating staff to be able to do that.
When you're at 183 per cent occupancy, then you're admitting kids that would normally be on the pediatric medicine ward to any place where there is a bed. And when there isn't a bed, unfortunately, then families — parent and sick child — have to wait in the emergency department until there is a bed.
It's just a heartbreaking situation for everyone.
You mentioned that you're opening up a second ICU. How do you staff that?
We can't hire fast enough, and there aren't enough people to hire. And so we do need to reallocate physicians and nurses and other staff from outpatient specialist clinics, from surgery, from other parts of the organization … to staff these extra beds, to staff the emergency department.
It's just awful because too many kids already wait too long for planned surgery or planned procedure. And now we're having to cancel those. And so we have not done any — I shouldn't say any, there's probably been one or two — but we've done hardly any spine, heart or brain surgery in the last month because that requires an admission to ICU for recovery, and we just don't have any ICU beds … we haven't done any so-called elective surgery. Obviously, urgent and emergent cardiac and neurosurgery and surgery still happens, but I'm talking about planned surgery.
They're not waiting for unimportant surgery, those parents and those kids, are they?
No. For example… talking to a mother a couple of weeks ago, whose child has scoliosis, and the curvature of the spine has gotten much worse as they waited for surgery; and their surgery was cancelled … a couple of days beforehand because there just was no bed capacity.
It's just hard on everyone…. Nobody here is happy with the situation as it is. It's just not OK.
That's the moral distress that health-care providers are experiencing because … a child who needs surgery or therapy or medical intervention … when they don't get it, it can affect their trajectory — can affect the trajectory of their [lives].
We have a children's health system that is too small for a growing child and youth population.- Alex Munter
As we pull out of this crisis situation, I think we have to recognize that, you know, the root cause is that we have a children's health system that is too small for a growing child and youth population. And the moral of this story is that we need to right-size the child health system.
How do you do that?
It's about building systems of care around kids' needs and kids' lives.
We need to bolster the capacity we have, and we need to develop new models of care. So, for example here at CHEO, we've created a new service in our mental health and addictions program called "One call, one click." It's through our Kids Come First health team that brings together 24 mental health and addictions agencies.
We've set up a couple of urgent care clinics … led by community pediatricians and family physicians, and that's been really, really important for us in being able to give families an alternative to the emergency department … But almost all of these initiatives, certainly the urgent care clinics and the "One call, one click," it's all on temporary money. The additional beds that we have at the moment — all on temporary money.
We do need to make permanent these investments in children's health, recognizing first of all, it's the right thing to do.
And secondly, that the dividends that it pays are considerable to the society as a whole, of course, but also to the health-care system later on. When we put kids on the path to lifelong health, that means that they will not be using as many health-care resources as they get older.
As you work your way through this crisis, what worries you the most?
What worries me the most of course is the kids and making sure that particularly children with serious and ongoing health issues get the care that they need; or if it's delayed, that it's not delayed so long that it changes the entire trajectory of their life.
That just weighs so heavily on all of us.
My other concern is for our own people who are doing this work … they're doing what needs to be done, and they're working extra shifts, and they're working around the clock, and they're thinking of new ways of doing things. But that's exhausting.
Written by Ruby Buiza. Produced by Colleen Ross and Jeff Goodes. Q&A edited for length and clarity.
