Ontario hospitals scrambling following surge in number of extremely sick babies

Hardest hit have been the three in Toronto - at SickKids, Mount Sinai Hospital and Sunnybrook Health Sciences Centre.

THestar.com
Aug. 25, 2017
By Theresa Boyle

A sudden jump in the number of extremely sick and premature babies has left Ontario hospitals scrambling to find space to care for them.

Most of the province's eight Level 3 neonatal intensive care units, which care for the most fragile newborns, have been struggling with an unanticipated surge in demand since early August, Ontario health officials have confirmed.

Hardest hit have been the three in Toronto - at SickKids, Mount Sinai Hospital and Sunnybrook Health Sciences Centre, said David Jensen, a health ministry spokesperson.

"This is an unusual situation that has not been previously encountered," he said in an email.

The province was unable to say Thursday exactly how many babies have been treated in these units in recent weeks.

Officials emphasized that all of the infants have received the care required, but conceded it has been a challenge.

The ministry is unaware of what has caused the sudden increase in demand and is studying what's behind it, officials said. Efforts are underway to ensure there is enough capacity in future.

"The ministry can confirm that there is no public health issue at hand causing more babies to require care. An increase in high acuity patients is being encountered, however, the ministry is not aware of any specific cause that has contributed to the surge," Jensen said.

"The needs of the broader patient population fluctuate and can place dynamic demands on the health care system," he added.

Dr. Richard MacDonald, a pediatrician at Halton Healthcare, publicly sounded the alarm over the problem on Twitter this week.

"Not enough NICU (neonatal intensive care unit) beds, equipment, RNs. UNACCEPTABLE. Where do we send these babies??" he wrote in a tweet directed at Ontario Health Minister Dr. Eric Hoskins and federal Health Minister Dr. Jane Philpott, among others.

"Do you know what it's like to tell terrified parents their sick baby may have to be flown to Ottawa or Buffalo? I do & I'm tired of doing it," MacDonald wrote in another tweet.

Provincial officials said no babies have been transferred out of province, including to Buffalo, something that often happened in the 1990s because of a shortage of bassinets here.

MacDonald forwarded to the Star email updates about the problem circulated by the Mississauga Halton Health Integration Network. (There are 14 such local health integration networks, or LIHNs, across Ontario. They co-ordinate local health services within different geographic regions.)

The emails revealed that health officials were holding daily teleconferences to deal with the problem until the middle of the month.

The situation is a "high risk for the system," stated an update sent out Tuesday.

"Acuity levels remain high, equipment is low and staffing is a great challenge with the number and acuity of patients at the sites," it continued.

On one day in early August, all three Toronto Level 3 units were completely full and closed to new admissions, an email update revealed. This week, only one bassinet was available at Sinai Health, stated another.

An emailed statement to the Star from the Toronto Central LHIN said: "The local capacity for high acuity neonatal care in Toronto Central LHIN has reached unprecedented volumes."

The LHIN said it is bringing in extra bassinets, which will be fully operational in September. Longer term, the Toronto LHIN said it will form strategies with provincial partners for managing the "acuity and volume of high acuity neonatal care if increased volumes persist."

In addition to Toronto and Ottawa, Level 3 units are also located in Kingston, London and Hamilton. Babies get transferred to units outside their communities when bassinets at their local hospitals are full.

Anthony Dale, president of the Ontario Hospital Association, said the shortage of bassinets for the sickest babies is symptomatic of a larger problem of hospital overcrowding. There is little wiggle room left in the hospital system to deal with sudden jumps in demand, he explained.

"The truth of the matter is that, at present, many hospitals are dealing with unusually high patient volumes. . . . The hospital sector is under significant stress and there is very little capacity left in the system to deal with new or unanticipated surges in patient volume," Dale said.

Last year's flu season was a particularly tough one for overcrowded hospitals and despite extra funding from the province, the challenges continue, Dale said.

"While the OHA is grateful for the government's investments in hospital services . . . funding is not yet keeping pace with rising costs and the pressures of a growing and aging population with increasingly complex health needs," he said.

Many hospital beds are occupied by elderly patients who no longer require acute care. They are too frail to return home and have nowhere else to go.

Hospitals were forced to open hundreds of beds last winter for which they had not budget for, Dale said, adding that many remain open to ensure ongoing access to patients.

Dale said the fact that hospitals are struggling to accommodate large patient volumes in what is usually a slow time of the year is worrisome. He is concerned hospitals may be in for another tough winter unless the province takes appropriate action.

"With months to go before flu season begins, warning signs, such as emergency department wait-time data, are illustrating that operational issues are already re-emerging. Even in July, when patient volumes are generally quite manageable, many hospitals are experiencing an unusually high number of patients, requiring the opening of new unbudgeted beds - a practice that can compromise the financial health of the organization," he said.

Dale urged the provincial government to provide hospitals with financial relief in its fall economic statement, as it did last year, as well as in next year's provincial budget.

"To ensure that Ontarians continue to have access to care, now and into the future, contingency measures are required in the coming months. . . . New aggressive investments are also needed in hospitals and across the continuum in the 2018 Ontario Budget to ensure ongoing access to high-quality care," he said.