Nearly 12,000 children are on the waiting list for surgery in Ontario, a situation officials at four major pediatric hospitals say is part of a much bigger problem they need help from the province to solve.
A wave of viral respiratory illnesses caused by a particularly bad strain of influenza and respiratory syncytial virus has swept through the Hospital for Sick Children in Toronto, McMaster Children’s Hospital in Hamilton, Children’s Hospital at the London Health Sciences Center and CHEO, a health and research center in Ottawa.
Hospitals say the surge has subsided after three difficult months in which operations were canceled and staff redeployed to help overburdened emergency and intensive care units.
But during that time, the surgical waiting list continued to grow. About half of its 11,789 children are waiting beyond the clinically recommended waiting time, which hospitals say is partly due to the respiratory rush and the COVID-19 pandemic.
“The fact that we’ve already come out of the wave and are still very tight helps show that we really need a big investment,” said Bruce Squires, president of McMaster Children’s Hospital.
The hospital’s surgical waiting list includes 2,332 children, Squires said, adding that 69 percent of those procedures are outside the clinically recommended wait time. He said more specialized operating room staff, such as nurses and anesthesiologists, were needed to deal with the situation.
Staffing is the main problem preventing the four hospitals from increasing operations.
Toronto’s SickKids, which has returned to 85 percent of its surgical capacity, said the waiting list will actually grow even if they restore full service levels. Last year, SickKids was operating at 100 percent capacity and the waiting list increased by 15 percent, said Dr. Simon Kelly, surgeon and assistant chief of perioperative services at the hospital.
And that was before the jump.
The waiting list at SickKids is 6,301 procedures. Hospital staff had to cancel 280 operations after reducing service levels in mid-November, with half of those procedures already completed or rescheduled.
Kelly said the hospital is working with regional facilities to roll out a new model that will have community hospitals take on more pediatric surgeries, possibly simpler day procedures.
Ontario Health, with support from the Ministry of Health, has helped set up meetings with regional health care providers and is helping to identify which procedures can be performed outside of the main pediatric hospitals, Kelly said.
“We need to really think about how we redesign pediatric surgery and how the service is delivered across the province,” Kelly said.
An empty operating room is seen at the Hospital for Sick Children in Toronto on Wednesday, Nov. 30, 2022. THE CANADIAN PRESS/Chris Young
Health Secretary Sylvia Jones is “in constant communication with pediatric hospital chief executives and has offered the government’s full support to do what we can to increase their capacity,” spokeswoman Hannah Jensen said.
Seniors hospitals across the province are dealing with their own huge backlog of surgery, which includes about 200,000 procedures. The province recently announced a move to expand surgeries for adults performed in private clinics to help that backlog.
Children’s hospitals held a meeting Thursday with Ontario Health as part of a new “surgical access” table to try to figure out how to deal with the backlog of surgery, said Nash Syed, president of Children’s Hospital London Health Sciences Centre.
The pediatric hospital said intensive care unit capacity increased during the jump by six beds for a total of 20. Four of those six new beds are being funded long-term by the province, Syed said.
The intensive care unit often ran at 130 percent at peak times, and the hospital’s emergency department reached peaks of more than 200 children a day in a space built to serve 120 patients a day.
“It’s too little,” Syed said. “We’re looking at how we’re going to rebuild our emergency department.”
The London hospital also had to cancel operations, but the move came more because of a lack of beds than a need to redeploy staff. They are now in early discussions with regional facilities to help establish a hub-and-spoke model similar to the one SickKids is working on, Syed said.
In 2020, it opened an operating theater for “minor procedures” in an effort to relieve pressure on the main one. Syed said about 100 children go through it a month, with the average time in the hospital totaling 1.5 hours.
“It’s faster than the operating room, it’s cheaper than the operating room,” Syed said. “It’s a perfect model, but we need to scale it up.”
In Ottawa, the spike has gotten so bad that Tammy DeGiovanni, senior vice president of clinical services and chief nursing officer, said finance and communications staff are helping nurses and doctors fill orders and answer phones.
CHEO reduced its operating room from eight rooms to five, allowing staff to shift to the emergency room and intensive care unit. But the volumes were so great that the hospital built a second intensive care unit, which the province has since funded to make permanent.
ICU capacity is now at 80 percent, instead of levels of 200 percent seen in the fall. And the operating room is working at full capacity again.
The hospital began sending surgeons to smaller hospitals to perform surgeries, which freed up an operating table at CHEO.
DeGiovanni was buoyed by hope after the ministry made permanent funding for the second intensive care unit, but said much more ministry change and investment was needed.
“There is a concern that both the ministry and the public will move on and that we will forget about this jump,” De Giovanni said.
“We need a constant infusion of funds for operations, we can’t just go year after year.”
“You can’t hire staff with lump sum dollars.”
This report by The Canadian Press was first published on January 22, 2023.
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