Teens sent to adult hospitals for surgery as crisis grows at McMaster Children’s Hospital
Hamilton's children's hospital is so overwhelmed that it's sending teens to adult hospitals for urgent surgery.
The Spectator has learned that youth age 16 and older who weigh more than 50 kg (110 pounds) will be sent to Juravinski or Hamilton General hospitals for urgent surgery requiring admission starting Saturday until further notice.
The drastic measure was not included in an update to the public Friday that stated McMaster Children's Hospital (MCH) is running low on supplies and emergency room wait times have shot up as high as 13 hours during a surge of viral illness.
Kids are so sick that McMaster's intensive care unit (ICU) has 25 patients - well above the provincially funded maximum of 19. Some are being cared for in medicine wards and the emergency room.
Critically ill teens age 14 and over are being transferred to adult ICUs under the province's direction. Neither Hamilton Health Sciences (HHS) nor Ontario Health have provided details around how many transfers have already taken place and where they've gone. HHS stated Friday that there will be transfers in the coming days and weeks.
These actions are only being taken because of the extraordinary pressure at MCH," stated a memo to HHS staff Friday.
The memo also reveals that MCH's catchment area has been modified so that sick kids from Kitchener-Waterloo, Wellington County, Cambridge and Guelph who would normally come to Hamilton are now being sent to London Health Sciences Centre.
McMaster Children's Hospital, like all pediatric hospitals in Ontario, is under immense and increasing strain," stated the memo from chief operating officer Sharon Pierson and surgeon-in-chief Dr. Stephen Kelly. It was provided to The Spectator by HHS upon request.
In-patient occupancy for pediatric beds at MCH is extremely high and significant surge capacity has been required to meet volume pressures. There is very limited physical space available to add areas where care can be provided."
McMaster's emergency department (ED) is seeing 190 to 200 children a day - 20 per cent higher than average for this time of year. It's closer to the numbers typically seen at the height of flu season in January and February, raising concern about what winter months will bring.
Given the large number of admitted patients waiting in the ED for a bed, the flow of patients is very challenged," stated the community update. Wait times in our pediatric ED are approaching 12 to 13 hours at times - with admitted patients often staying more than 24 hours before they can move to an in-patient bed."
Occupancy is over 140 per cent at McMaster - up from 135 per cent last week. Anything over 100 per cent requires opening beds that aren't funded by the province and finding a way to staff them. Occupancy that high is unusual even for chronically overcrowded adult hospitals.
The pressures ... continue to escalate," stated the update. We are running low on supplies such as pediatric Tylenol and Advil. However, we are continuing to meet the needs of patients in hospital who need these medications most urgently."
The crisis at McMaster has been growing over the last two months caused by a sharp rise in viruses such as influenza, respiratory syncytial virus (RSV) and COVID, as well as increased illness due to delayed care over the pandemic.
The surge is increasing so fast that McMaster currently has 53 kids admitted with flu, RSV and other viruses compared to 14 on Oct. 31.
The hospital was already in what it called a very extreme situation" by the end of October, with president Bruce Squires expressing concern about the ability of staff to continue to meet the unprecedented demand.
Our critical care unit and emergency department are facing significant patient volumes driven by an unusually high seasonal surge in viral illnesses," stated the update. This is not isolated to MCH and is being felt across the province."
To try and cope with the surge of sick kids, MCH has already cut planned surgeries that require a hospital stay to five a week - one-third as many as the usual 15. The reduction started Nov. 4 and is expected to last at least four weeks.
The cancelled surgeries came weeks after Squires raised alarm that backlogs had reached the point that 60 per cent of kids waiting were missing the optimal window recommended to ensure there are no lifelong consequences for development.
Surgeries that don't require a hospital stay have continued at MCH regardless of age. The highest priority surgeries will also still be done at the children's hospital for all ages.
But youth age 16 and 17 coming to McMaster's emergency department in need of urgent surgery requiring hospital admission will now be sent to Juravinski or Hamilton General if they also meet the weight requirement. The teams caring for them there will be supported remotely by staff at the children's hospital.
We recognize the impact that such difficult decisions may have on our teams and for the patients and families we serve," stated the memo.
To help free up space at the adult hospitals, HHS has looked to transfer patients that could be cared for at St. Peter's Hospital, which specializes in complex continuing care, or the Satellite Health Facility, which is located in a former downtown hotel and primarily looks after those waiting for other types of care in the community.
We recognize that the pressures across all of our sites is intense," stated the memo.
To meet the unprecedented demand, McMaster is looking to expand its overcrowded emergency department.
Planning is underway to utilize clinic space after hours to manage the high volume of patients," states the update.
HHS has also asked staff at other sites to volunteer to come and assist McMaster. But the entire network is dealing with crippling staff shortages.
McMaster alone had 425 job openings - 123 of them in nursing - from July to October.
We sincerely appreciate the work of all our staff and physicians to support patients and their families at this very trying time," said the memo.
HHS is also counting on the public to do its part to help take pressure off McMaster.
It's important that everyone, including children, get a flu shot and stay up to date with COVID vaccines and boosters," states the update. If you have symptoms of flu or COVID you should also stay home, regardless of rapid test results, to reduce spread of viruses."
Joanna Frketich is a health reporter at The Spectator. jfrketich@thespec.com