McMaster Children’s Hospital running out of cribs during crisis expected to get worse

Hamilton's children's hospital is running out of cribs and infusion pumps used to deliver fluids and medication during a surge of viral illness that is only expected to get worse.

Certainly we are planning for this to continue and for the possibility that the convergence of RSV, influenza, COVID-19 and other viral illnesses - along with the key impacts of delayed care - will cause this to surge even further," McMaster Children's Hospital (MCH) president Bruce Squires said during a media briefing Tuesday. There's a lot of time left in what is traditionally the children's viral season and so we really have no choice but to plan for the possibility that this will continue and, in fact, get worse."

The province has given McMaster $1.3 million to expand the emergency department, open new beds and fund alternatives to kids coming to the hospital, such as urgent care.

However, MCH is still overwhelmed with an occupancy between 130 to 140 per cent. Anything over 100 per cent requires opening beds not funded by the province and finding a way to staff them.

The situation has become so dire that critically ill kids are being cared for outside of the intensive care unit because it is also overcrowded at 109 per cent occupancy.

I look at some of my colleagues that are working in the trenches and my heart bleeds - they're every day just going more and more," said Dr. Devin Peterson, chief of pediatric surgery. The stress level for the parents, the children, the staff, everyone in the hospital right now, is very high."

McMaster has had to significantly cut back on surgeries that require a hospital stay.

MCH is preparing to transfer teens to Hamilton adult hospitals for critical care and urgent surgeries - Squires said none have been transferred yet. Discussions are also taking place on whether there is anywhere else the teens age 16 and 17 could go for surgery.

Decisions have to be made every day about which procedures are most urgent and which will cause the most harm to wait, including tumours and surgeries that affect bladder function.

This is very stressful," said Peterson. It's very difficult to make these decisions."

McMaster's chief of pediatrics urged Hamiltonians to do their part to take pressure off of the hospital by wearing masks in indoor public and social settings as recommended by Ontario's chief medical officer of health and staying up to date on flu and COVID shots - including kids getting vaccinated.

Clearly masking works," said Dr. Angelo Mikrogianakis. The best ways I can summarize trying to mitigate the level of illness in your own home, in your own family, and in our communities is through immunizations and beginning to use masks again - and then appropriately accessing the health-care system."

About 200 kids are coming to McMaster's emergency department a day - 20 per cent higher than historical averages.

As of Tuesday, 15 kids were waiting in the emergency department to get a bed on a ward - a wait that has stretched as long as 24 hours.

The number of children having to wait in the emergency department for an in-patient bed is up 225 per cent from historical averages.

This situation is truly unprecedented," said Squires. The team at MCH and across Hamilton Health Sciences is putting forth extraordinary effort to manage this health-care crisis."

Traditionally, hospitals are most strained in the winter months - primarily in December and January, when respiratory viruses are at their peak. Mikrogianakis said McMaster tends to have about 40 kids admitted to acute pediatric care at any one time during the winter. That number goes up to about 55 during surges that pose significant challenges to the system.

But the current spike that started in October has seen the number of kids admitted shoot up to 75 to 80, leaving the hospital literally running out of space. Mikrogianakis said it's like McMaster is all at once getting the surges that never happened in 2020 and 2021, on top of an early start to the 2022 season.

We are seeing three winter surges in one," he said. It's going to be longer and ... challenge our hospital capacity and our responsiveness and our supports for sick children more than we've probably ever seen in my career."

The surge has left McMaster running short on resources - first and foremost staff. MCH had 425 job openings - 123 of them in nursing - from July to October. Staff from other sites have been asked to voluntarily go and help McMaster but the entire hospital network is suffering from unprecedented shortages.

The main challenge in terms of the things we need to care for patients is on the human resource front in terms of staffing and skilled staff to care for sick patients," said Mikrogianakis.

The next serious shortfall has been children's Tylenol, Advil and common antibiotics.

I know that the various levels of government are working to correct those things," said Mikrogianakis. But in a capacity surge you need all aspects of the system working above regular capacity to be able to deal with these things."

In addition, the hospital has literally started to run out of beds and associated equipment.

It really speaks to the magnitude of the surge that is pressuring us right now," said Squires. Things like pumps that are for timely and appropriate medication administration and also, really uniquely, cribs.

Certainly, this surge is particularly impacting younger children and so we are starting to exceed our supply of appropriate beds."

CORRECTION: An earlier version of this story contained incorrect information about patient transfers. HHS is preparing to transfer teens age 16 to 17 for surgery and teens age 14 and over for critical care at adult hospitals. It's also looking into whether there is anywhere else it can send teens for surgery.

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