Ethan Rhodes
The COVID-19 pandemic has strained Ontario's critical care system, with hospitals struggling to accommodate the surge in coronavirus patients. To address this, the Ontario government has added hundreds of critical care beds and is working to find staff and space for more. Hospitals in the Greater Toronto Area have been ordered to close their pediatric units, with patients being transferred to Toronto's SickKids hospital, which has opened eight adult ICU beds. The Ontario Critical Care COVID-19 Command Centre directed the transfer of 976 critically ill patients between and within regions from January 5, 2021, to July 4, 2021. The pandemic has also highlighted the importance of adequate nursing staff in ICUs, with models such as the team-based model of care being implemented to expand the capacity of the province's critical-care-trained nursing workforce.
| Characteristics | Values |
|---|---|
| Number of ICU beds in Ontario hospitals | 98 on any given day |
| Number of COVID-19 patients in ICU beds | 416 on Monday |
| Number of new ICU beds to be added | 350 |
| Number of new hospital beds to be added | 500 |
| Number of COVID-19 patients in ICU as of Sunday, January 9, 2022 | 412 |
| Number of new ICU nurses wanted | 1,111 |
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What You'll Learn
Ontario hospitals' ICU bed capacity
Ontario hospitals have been under immense strain due to the COVID-19 pandemic, with ICUs reaching capacity and threatening the province's critical care capacity. In response, the Ontario government has taken steps to increase ICU bed capacity and manage the influx of patients.
On any given day, there are about 98 beds designated for critical care across the province. However, the pandemic has caused a rapid rise in hospitalizations and ICU admissions, leading to a shortage of beds and staff. In January 2020, before the pandemic, hospital gridlock was already a routine issue in Ontario, with beds in hallways and conference rooms. During the pandemic, hospitals in the Greater Toronto Area had to close their pediatric units, transferring patients to Toronto's SickKids hospital, which opened eight adult ICU beds.
To address the bed shortage, the Ontario government announced plans to open 500 new hospital beds, including those in a new facility north of Toronto. Additionally, 350 new ICU beds were to be added by the end of one week in May 2021, according to Health Minister Christine Elliott. This was in response to the third wave of the pandemic, which saw several provinces break records for new daily COVID-19 cases, hospitalizations, and ICU admissions.
The Ontario Health Minister also stated that efforts were underway to find space in hospitals in virus hotspots and staff to oversee the new beds. This included the addition of 3,100 healthcare beds as part of the government's COVID-19 response. However, the government could not specify how many of the new beds would be fully equipped for critical care or when they would become operational.
The strain on ICU capacity in Ontario hospitals has led to the implementation of various strategies, such as the ""team-based model of care." In this model, acute care nurses from other hospital areas were redeployed to ICUs, providing care within their scope of practice. ICU nurses were assigned to multiple patients, supporting the redeployed nurses and overseeing their care. This model helped expand the province's critical-care-trained nursing workforce but relied heavily on the redeployment of acute care nurses.
While the additional beds and staffing adjustments helped manage the situation, Ontario continued to face challenges with ICU capacity and healthcare worker burnout. As of January 2022, Ontario reported 412 COVID-19 patients in intensive care units, a rise from previous days, indicating continued strain on the healthcare system.
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Staffing ICUs in Ontario
The COVID-19 pandemic has strained Ontario's critical care system. To address the surge in hospitalizations, the Ontario government has taken steps to increase the number of ICU beds available. However, simply increasing the number of beds is not enough; these beds need to be staffed by qualified healthcare professionals.
One common strategy has been to redeploy acute care nurses from other areas of the hospital, such as surgical wards and operating recovery rooms, to work in ICUs. This "team-based model of care" enables one critical care nurse to oversee the care of many ICU patients, with the support of redeployed acute care nurses. While this approach has helped expand the province's critical care nursing workforce, it relies heavily on the availability of redeployable nurses.
Additionally, hospitals have adjusted nurse-to-patient ratios to manage the increased demand. In non-surge scenarios, it is standard for each ICU patient to have one dedicated nurse. However, during the pandemic, it became common for nurses to be assigned to two or more patients, especially as hospitals cancelled elective operations to free up resources for COVID-19 patients.
Despite these efforts, the strain on Ontario's healthcare system has persisted. Staffing ICUs remains a challenge due to worsening staffing shortages, healthcare worker burnout, and health system recovery efforts. The situation has been further exacerbated by the highly contagious Omicron variant, which has resulted in even higher numbers of COVID-19 patients requiring intensive care.
To address the ongoing staffing challenges in ICUs, Ontario has focused on increasing the number of qualified healthcare professionals. This includes recruiting and training additional nurses and physicians with critical care expertise. Additionally, efforts have been made to retain existing healthcare workers by providing them with the necessary support and resources to manage the physical and mental demands of working in high-pressure ICU environments.
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COVID-19's impact on Ontario ICUs
Ontario hospitals have been significantly impacted by the COVID-19 pandemic, particularly with respect to their intensive care units (ICUs). The pandemic has exposed the delicate demand-capacity balance in ICUs, with a critical need for trained healthcare professionals to increase ICU capacity.
In November 2020, Ontario reported 150 COVID-19 patients in ICUs, surpassing a key threshold that made it challenging for hospitals to manage non-COVID patients and procedures. This surge in COVID-19 cases pushed the healthcare system to its limits, necessitating the transfer of patients to hospitals in other regions. In response, the Ontario government, in consultation with the Chief Medical Officer of Health, took decisive action to ensure bed availability for COVID-19 patients requiring urgent care.
To address the critical situation, the Ontario government announced plans to open 500 new hospital beds, including those in a soon-to-open facility north of Toronto. This was welcomed by hospital officials, who warned that without additional capacity, they might have to make difficult life-and-death decisions. The government also aimed to add 350 new ICU beds by the end of the week, according to Health Minister Christine Elliott. However, the challenge of finding enough specially trained nurses and doctors to staff these extra critical care beds remained, potentially requiring staff redeployment and further cancellation of non-COVID-related operations.
The pandemic's impact on ICUs in Ontario was influenced by the timing of public health measures. Provinces that delayed implementation and prematurely relaxed restrictions experienced more severe consequences. The situation was exacerbated by the need to redeploy PICU nurses to adult ICUs and long-term care facilities, with some contracting COVID-19 and becoming unavailable for an extended period. Additionally, the focus on the relatively low number of severe pediatric cases may have led to an underestimation of the pandemic's impact on PICU resources.
The COVID-19 pandemic has highlighted the importance of maintaining a high level of immunity in the population, including booster shots, to prevent ICUs from becoming overwhelmed. Unvaccinated individuals in Ontario are significantly more likely to require ICU care compared to those who have received vaccinations and booster shots.
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ICU admissions in Ontario
Ontario hospitals have been under immense pressure due to the COVID-19 pandemic, with a rapid rise in hospitalizations and ICU admissions threatening the province's critical care capacity. The Ontario government, in consultation with the Chief Medical Officer of Health, has taken steps to ensure bed availability for COVID-19 patients requiring urgent care.
During the pandemic's peak in April 2020, hospitals in Ontario reported being overwhelmed by COVID-19 admissions. Markham Stouffville Hospital outside Toronto offered a glimpse inside their ICU to emphasize the seriousness of the situation. They shared that patients were staying longer in ICUs, which posed a challenge.
To address the surge in ICU admissions, Ontario Health instructed hospitals to find staff and space for additional beds, many of which would be ICU-like beds operated with fewer staff. The province planned to add 350 new ICU beds by the end of a particular week, according to Health Minister Christine Elliott. Additionally, hospitals in the Greater Toronto Area were ordered to close their pediatric units, transferring patients to Toronto's SickKids, which also opened eight adult ICU beds.
The "team-based model of care" was implemented to address staffing shortages. Acute care nurses from other hospital departments were redeployed to ICUs, providing care within their scope of practice. ICU nurses were assigned multiple patients and supported the redeployed nurses. This model helped expand the capacity of the province's critical-care-trained nursing workforce. However, it relied heavily on the availability of acute care nurses.
Despite these efforts, the critical care system in Ontario faced challenges due to worsening staffing shortages, healthcare worker burnout, and health system recovery efforts. By November 2021, the system could not accommodate a surge in patients as it had during previous waves of the pandemic.
As of January 2022, Ontario reported 412 COVID-19 patients in intensive care units, a rise from previous days, indicating a continuous strain on healthcare workers and resources.
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Ontario's ICU triage guidelines
Ontario hospitals received a document in January 2020, laying out guidelines on how to deal with critical care triage. The document, titled "Adult Critical Care Clinical Emergency Standard of Care for Major Surge", stated that patients will be scored by doctors on a "short-term mortality risk assessment". It advised hospitals to aim to "prioritize those patients who are most likely to survive their critical illness". This means that patients with a high likelihood of dying within twelve months of the onset of their critical illness would have a lower priority for critical care resources.
At Level 3 triage, patients with a predicted mortality rate of 30 per cent—or a 70 per cent chance of surviving beyond a year—will not receive critical care. Clinicians may abandon short-term mortality predictions in favour of randomization, which the document noted should be used "as a last resort" and conducted by an administrator.
The Ontario government, in consultation with the Chief Medical Officer of Health, is taking action to ensure hospital beds are available for COVID-19 patients in need of urgent care. In April 2021, Ontario Health Minister Christine Elliott said that efforts were underway to find space in hospitals in virus hotspots and to find the staff needed to oversee new beds. However, the government could not say how many of the new beds would be fully equipped for critical care or when they would be operational.
The Ontario Hospital Association praised the use of the Vaughan Hospital to ease pressure on the GTA healthcare system and the pledge of 500 more beds. However, they warned that once the number of COVID-19 patients in ICUs exceeds 700, doctors could be forced to make difficult triage decisions.
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Frequently asked questions
While an exact number is not available, many hospitals in Ontario have ICUs. Some of these include Markham Stouffville Hospital, Toronto's SickKids, and Michael Garron Hospital.
On any given day, there are about 98 beds designated for critical care across the province. However, Ontario has been adding more ICU beds to meet the demand due to the COVID-19 pandemic. For instance, in February 2021, the Ontario government announced plans to open 500 new hospital beds, including those inside a new facility north of Toronto.
According to Michael Warner, to run a 17-bed ICU 24/7, 54 full-time equivalent ICU-trained registered nurses are required. To operate 350 new ICU beds and maintain the same quality of care, 1,111 registered nurses are needed.
The COVID-19 pandemic has strained Ontario's critical care system. From March 20, 2020, to October 31, 2021, 9,096 Ontarians were admitted to ICUs with COVID-19-related critical illnesses. During the third wave, the number of patients on ventilators was over 180% of pre-pandemic historical averages.
