Hundreds of kids face the worst wait in Ontario for surgery at McMaster Children’s Hospital

The president of McMaster Children's Hospital says Hamilton has the worst wait in the province for pediatric surgery.

Bruce Squires says 2,100 kids are waiting for surgery at McMaster and 65 per cent of them have already missed the optimal window recommended to ensure there are no lifelong consequences for development.

Surgery is recommended within particular time frames because that can be important for the child's future physical development but sometimes also their educational, emotional and mental health development," said Squires. That's why we're so, so concerned any time that a child or youth has to wait beyond what is recommended for a surgical procedure."

Squires first raised alarm about the backlog in pediatric surgery in October when 60 per cent of kids were waiting longer than optimal. Chronic overcrowding and unprecedented staff shortages at the children's hospital on Main Street West have only exacerbated the situation.

Having to live with pain as a child can do things like affect their ability to go to school, their ability to participate in sports and in other activities, their ability to concentrate, to learn and really to be a kid," said Squires. That places tremendous burden and often anxiety on parents as they watch their kids suffer."

For the roughly 1,400 kids who have waited too long, it can shape their trajectory going forward, said Squires, giving the example of a child needing spine surgery.

If we delay the surgery for a child as they are experiencing curvature of the spine, that can allow that curvature to worsen," he said. The more that curvature worsens, the greater the likelihood that the surgery won't completely correct that curvature and the greater the likelihood that the child could experience future challenges - be it respiratory, be it range of motion, be it the ability to be active and engage."

To address the backlog, McMaster asked for provincial funding to increase the amount of surgery it can do by 33 per cent about 18 months ago. It also requested the addition of four post-surgical beds to bring its total up to 23.

The province hasn't responded yet, but Squires is optimistic after the budget tabled in March committed around $200 million to improving pediatric care, including surgical and diagnostic wait times. The money comes from the $4.4 billion health-care deal with the federal government.

I'm confident that if we can move forward with these proposals, we'll make a big dent, particularly in the number of kids that are over the recommended wait time and also in the overall waiting list," said Squires. It really is clear that we need to do some of the pieces of our comprehensive plan for surgical recovery that haven't yet been approved."

McMaster has already moved forward on another key piece of the plan that allows kids to stay overnight in the recovery room for observation after surgery without being admitted to the hospital. The Same Day Overnight (SDO) Surgical Unit opened on Tuesday.

There are a significant number of children who receive surgery who really would benefit from overnight observation but don't need to be in a formal in-patient bed," said Squires. Sometimes because all of our beds are already occupied, we would have to cancel or not even schedule some of these surgeries. But by having the same day overnight available there's less likelihood that we'll have to cancel that procedure."

The SDO unit will care for four to six kids a day Monday to Friday, totalling up to 30 a week.

This is an exciting, important first step toward really getting at our pediatric surgical wait list," said Squires. This is one piece of that goal to right-size the child health system."

SDO units have existed in Hamilton's adult hospitals for about a decade. Hamilton Health Sciences (HHS) has three - two for general surgery located at Hamilton General Hospital and Juravinski Hospital and one dedicated to hip and knee replacement at Juravinski.

We can get a fairly significant amount of surgery through by using the infrastructure of the recovery room on the night shift," said Leslie Gauthier, vice-president of surgery at HHS. From our adult experience, it can be done and done very safely."

There hasn't been a push to open an SDO unit at McMaster until recently because pediatrics traditionally didn't have the same long-standing overcrowding issues as adult hospitals that can cause surgeries to be cancelled or limited because of a lack of in-patient beds.

The real pressure we felt in children's really came with the pandemic," said Gauthier. Over the recent year, one of our major challenges in getting pediatric surgeries completed has been the ability to have an in-patient bed for those children that need to be admitted. That's just because of all the pressures on the beds with influenza, COVID and RSV (respiratory syncytial virus)."

For more than a year now, Squires says McMaster has consistently had an occupancy of 100 per cent or higher, meaning all funded beds are full. Anything above 100 per cent occupancy requires hospitals to open beds not funded by the province - sometimes in unconventional spaces like hallways or family rooms - and find a way to staff them. It has hampered the ability to ramp up surgery.

Without the same day overnight unit, those children's surgeries could only go if we knew we had a ward bed," said Gauthier. So it's going to allow us to get more pediatric surgery through because we're not going to be as dependent on having an in-patient ward bed."

There are 11 types of surgeries approved for the SDO unit - none require cardiac monitoring post-operatively. The stays are short with kids discharged at 7 a.m.

Fingers crossed that we can move some kids through that have these elective surgeries that need to be done," said Maureen Williamson, bargaining unit president and local co-ordinator of the Ontario Nurses' Association (ONA) Local 70 at HHS.

She said the union collaborated with the hospital to create the SDO unit and has no concerns regarding its safety, especially considering the practice is already well established in adult care.

The unit was set up with money from the provincial Surgical Innovation Fund that was created to help reduce the pandemic backlog. Squires is confident the province will continue to fund it for the fiscal year that started April 1.

It was originally scheduled to open in January, but Gauthier said it took until now to recruit the three nurses needed to staff the unit.

Staff shortages have also limited the use of a new operating room for adults at Hamilton General Hospital that opened in December. It's being used only three days a week by the burn unit so far because there aren't enough staff to open it up on additional days or to other programs.

In addition, McMaster's plan for surgical recovery would require recruiting staff, particularly pediatric anesthesiologists.

It also calls for the government to fund technology like virtual nursing visits to allow McMaster to discharge surgical patients home sooner.

We're certainly working as quickly as we can with government and continuing to encourage that final step of making those investments," said Squires. It is really important. Our wait for kids for pediatric surgery, I think it's fair to classify it as the worst in the province."

Joanna Frketich is a health reporter at The Spectator. jfrketich@thespec.com