Overcrowding at McMaster Children’s Hospital leads to long ER and surgery waits for kids

Kids are waiting 24 hours in the emergency department to get a ward bed because of unprecedented overcrowding at McMaster Children's Hospital.

Occupancy has been between 115 and 130 per cent for pediatric acute care and surgical beds in recent weeks. A hospital is full when occupancy hits 100 per cent - meaning all beds funded by the province are taken. Ideally, occupancy should be between 85 and 90 per cent.

When you've got high in-patient occupancy, you don't have the flow that allows you to be able to admit patients quickly from the emergency department or from our surgical floors," said hospital president Bruce Squires. So we were experiencing very long stays in our emergency department."

The overcrowding comes as the hospital faces unparalleled staff shortages. Over the past three months, McMaster Children's has had 425 job openings - 123 of them in nursing - for pediatrics and adult care offered at the site.

The pressures are quite significant when you layer on the challenges with health human resources," said Squires. Certainly our teams are very pressed. You could say that they're struggling to meet this demand."

The strain makes it hard for the hospital to catch up on a backlog of roughly 1,400 kids waiting for surgery. Delays reached the point by the spring that 60 per cent of kids on the list did not get their surgery within the optimal window recommended to ensure there are no lifelong consequences for development.

Children waiting too long for surgery has roughly doubled over the course of the pandemic - fewer than 30 per cent of kids didn't get their operation on time before COVID. Squires expects the number has only gotten worse since the spring.

We've not been able to do the number of surgeries that we'd like because of health human resource challenges as well as some of our bed pressures that mean sometimes we don't have a bed for a patient requiring surgery so we have to cancel that surgery," said Squires. Those numbers of kids waiting longer than recommended has probably grown even higher than that 60 per cent."

The crisis in pediatrics is being seen across the country, says Children's Healthcare Canada, a national association made up of children's hospitals and health organizations, including McMaster.

It is a concerning trend," said association CEO Emily Gruenwoldt. What that really means at the end of the day is children might be waiting in discomfort, they might be waiting in pain. Their condition might be growing more complex as they wait. It might be a more complicated intervention when the time of surgery actually takes place. It could also compromise their overall outcomes."

She also expects the problem is only getting worse.

Reflecting on our capacity to actually make gains on that backlog, it becomes harder and harder with each passing day," said Gruenwoldt. Some of these organizations, they've never seen this level of volume before."

At McMaster Children's, emergency department visits have been up 10 per cent compared to pre-pandemic levels for months. But they spiked to more than 20 per cent higher over the summer.

Kids are also sicker with more of them needing to be admitted to the hospital. It creates a log jam in the emergency department of children waiting for beds in wards that are already full.

As a result, length of stay in the emergency department was up 50 per cent compared to before COVID. The amount of time it takes to get a kid into an in-patient bed has doubled.

The hospital has tried to reduce the waits by opening up as many as 12 unfunded beds and putting kids on wards where they normally wouldn't be treated.

But on Tuesday, there were still 11 kids waiting in the emergency department to go to a ward - a number of them had been there almost 24 hours.

Squires called the overcrowding much longer and more significant than I think any of us can remember."

In the heart of flu season in December and January, February of most years, children's hospitals would be challenged with our capacity, and certainly that's gradually been increasing," said Squires. But this particular year, I think we're seeing a much longer, sustained and more significant period of capacity pressures."

The reasons for the unusual demand include increased viral activity, difficulty getting home care for children needing to be discharged, postponed care leading to sicker kids and the ongoing pandemic. It has raised concern about the coming flu and virus season alongside a forecasted rise in COVID.

There's no question that we do have concerns about the possibility that these pressures and volumes that we're seeing will grow over the next few months," said Squires. At the same time, we're also worried about the impact on our workforce, which is already quite strained."

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