Ontario hospitals asked to treat kids 14+ who need ICU care as pressures mount on pediatric hospitals

The head of Ontario's critical care COVID-19 command centre has asked the province's hospitals that treat adults to also accept children 14 and older in need of intensive care to relieve pressure on pediatric hospitals.

Surgeries may need to be cancelled as a result, Dr. Andrew Baker wrote to hospital CEOs in a memo.

Baker said the moves are being made due to the "current and impending surge in pediatric critical care demand."

"It is anticipated that the next two to three months will bring significantly increased demands for pediatric critical care support that will be sustained and characterized by unplanned surges that may occur with very short lead time," Baker wrote in the Wednesday memo.

Baker, the head of Ontario's critical care COVID-19 command centre, also asked hospitals to maximize intensive care capacity to help relieve the burdens on emergency departments.

"The Ontario Critical Care COVID-19 Command Centre is requesting that people aged 14 and over requiring critical care (in the context of a directive or not) are managed in adult critical care beds," Baker wrote.

"There may be some exceptions to be evaluated on a case-by-case basis."

In a statement to CBC News, a spokesperson for Minister of Health Sylvia Jones said the government is "not okay with the status quo."

"That is why we have invested in health human resources, freed up beds across the province and expanded 911 models of care to address wait times as demand rises heading into the fall and winter season," the statement says in part. 

"This fall, Ontario Health provided direction for all pediatric hospitals to have a surge plan in place to respond to increased demand. All Ontario hospitals have also been directed to use adult hospital capacity to support pediatric surges."

'Unprecedented' number of ER arrivals

At Toronto's SickKids Hospital, president and CEO Dr. Ronald Cohn says there's already an "unprecedented" number of children arriving at the emergency room, some who need to be admitted to regular wards and others who need intensive care.

Cohn told CBC News children are arriving with a number of respiratory conditions — with only a fraction stemming from COVID-19.

"There's no question that the pressure on the healthcare system and specifically the pediatric healthcare system will continue to increase over the next few weeks," he said, pleading with everyone to get their flu shot and COVID-19 booster doses as soon as possible. 

CHEO, the children's hospital in eastern Ontario, says it too is seeing a surge in young patients with respiratory infections that has put it well over capacity and resulted in "historically long" wait times.

Tammy DeGiovanni, senior vice president of clinical services with CHEO, said Thursday that although "every little bit helps," the decision to manage teenage patients in adult critical care beds is unlikely to reduce the patient burden.

The hospital sat at around 160 per cent capacity on Thursday, she said, and every one of those patients was five years old or younger. The "vast majority" of those, she added, are under the age of two.

"We really need to do what we can to look after those children here because we really aren't able to send them anywhere else," she said.

Requests to be reviewed every 2 weeks

A number of children's hospitals in Ontario have said recently they are being overwhelmed with children needing intensive care.

There are 107 children in critical care across the province, only four with COVID-19.

Baker wants hospitals to "proactively create and sustain additional capacity in adult critical care."

He also wants hospitals to "be available to respond within 24 hours to directives" from the command centre.

"We anticipate that (the request) may require hospitals to manage their resources and may result in the need to ramp down surgical/procedural volumes," Baker wrote.

Baker said the requests are temporary and correspond with the "predicted surge period" and will be reviewed every two weeks.