Inside SickKids: Overworked emergency departments brace for new surge

A security guard guards the waiting room of the emergency department at the Hospital for Sick Children in Toronto as a baby’s screams are heard in the distance.

Parents hugged their sick children while others rocked theirs in prams. A toddler sits on a bed and sucks on a pacifier, with a tube under her nose helping her breathe.

Everyone is exhausted.

On this recent afternoon, the wait time for an appointment was about three hours — much shorter than it was just a few weeks ago, when the country’s largest pediatric hospital saw an unprecedented surge in the number of children with respiratory illnesses.

That’s when wait times skyrocketed, frustrated parents lost their tempers and the hospital had to hire a security guard to protect staff for the first time. After taking several steps to relieve the pressure, the emergency department is now back to its typical volume for this time of year — about 240 children a day.

Employees are now bracing for another wave that hits at the worst possible time: the always busy holiday season. They are already worried.

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“I get yelled at a lot,” says Dr. Sasha Litwin, who just got off work.

“I try to tell people: ‘I think this sucks too, you shouldn’t wait 16 hours, but it’s just me and I can only really see one person at a time.'”

One child recently spent 36 hours in the waiting room, Litwin said.

“It’s really bad,” she said. “But we’re just working as hard as we can, doing the best we can with the resources we have.”

The Canadian Press recently spent hours inside SickKids to better understand the massive challenges pediatric hospitals face and the ways they are addressing them.

On this day, at 3:40 p.m., the emergency room was quiet.

Screens at the entrance showed that the longest wait was nearly three hours, with 31 patients yet to be seen. To date, the unit has seen 66 patients. Thirty minutes later, the wait time jumped to 3.5 hours. The department is packed at night and may see more than 200 patients by the end of the day.

Dr. Jason Fischer, chief of emergency medicine, said the recent slight slowdown has helped staff regroup.

“It’s been a good reprieve for two weeks to give people a breather,” he said.

Earlier this year, staff were concerned that winter would be tough after watching Australian hospitals struggle with respiratory illnesses during the typical cold and flu season.

In September, SickKids noticed an increase in respiratory illnesses.

In October, it began to see the volumes typically experienced on Boxing Day – typically the busiest day of the year for hospitals, with around 320 patients being treated as most home and walk-in clinics are closed.

“We don’t expect to see those numbers on a Wednesday in October,” Fischer said. “Boxing Day is one day, not six weeks.”

He recalls one night when there were 75 children in the waiting room.

“Every kid looked the same, every kid was under four years old, they all had a fever and they all had a high heart rate,” Fischer said. “But something more sinister may be coming to some of these kids, and that’s a real concern for us.”

The number of patients is so high that the hospital built a new waiting room for the department in the cafeteria, where more than 60 families can wait and even receive treatment if necessary. Plexiglass separates patients from diners.

Compounding the problem is a nationwide shortage of acetaminophen and ibuprofen for children. Fischer said the family went to the emergency room to get medicine for the child’s fever that they wouldn’t otherwise have needed to go to the hospital.

Staffing was also a “real challenge,” Fischer said. Nurses have left in large numbers during the pandemic, while others have gotten sick from the spread of respiratory viruses.

“We’ve been calling backup,” he said. “The risk of burnout is high and there are real concerns about the health and retention of our workforce.”

The emergency department has about 39 patient beds, though that’s pushing it, Fischer said. On most days, patients often pour into the beds of the nearby orthopedic clinic by 4 p.m. The department has the money and staff to see 65,000 patients a year, but is on track to see more than 90,000 children this year, about 8,000 more than ever before.

Hospitals have tried a few ways to ease the overwhelming pressure on emergency rooms.

SickKids promoted use of its virtual urgent care program, which jumped from about 40 patients per day to more than 200 in October and November.

It is also diverting some patients by using a digital screening tool launched on a mobile phone with a QR code. If children do not require urgent care, they are referred to the hospital’s express pediatric clinic for primary care.

SickKids also posted instructions on its website how to give children adult acetaminophen and ibuprofen, while hospital staff gave parents practical instructions on how to cut, crush and mix the pills with applesauce or yogurt. Instructions.

The unit, like the intensive care unit, has also benefited from the hospital’s difficult decision to cancel some procedures, allowing four operating room nurses to be redeployed.

Hospitals are experimenting with new roles, such as “greeters” who help communicate with families and assist with patient flow. Emergency medicine technicians are also being trained in blood collection to further reduce the pressure on nurses, Fischer said.

Staff also have apps on their phones that send alerts when patient flow slows in an area so resources can be adjusted.

All steps will help improve the situation, but Fischer is concerned about the months ahead.

“We can’t keep it that way for long,” he said. “We were really pushed to the brink and we were having some trouble keeping every patient safe.”

Internal tests at SickKids have shown a severe strain of influenza A is clearly on the rise, while respiratory syncytial virus (RSV) is waning. The hospital believes the surge in respiratory illnesses is likely to continue into March.

The whole situation led to a noticeable drop in staff morale, said Elise Gabriele, a physician assistant who has worked at the hospital for four years and often conducts initial patient assessments.

It’s back to long wait times and frustrated parents, she said.

“It made communication more difficult,” Gabriele said.

“Trying to take the time to help with that frustration while still trying to provide the best care is making the job that much more difficult. We’re also not happy with the wait times.”

Health care workers say the public can help.

“If you’re able to get a COVID booster and a flu shot, I wholeheartedly recommend it,” says emergency physician Litwin. “It’s going to make a big difference.”

Now hospitals wait, hoping the next wave won’t be as devastating as the first.