One year ago, Royal Victoria Regional Health Centre (RVH) was preparing for an intensive-care crisis that never really materialized. Instead, COVID-19 befell the long-term care sector.
Now the head of the Barrie hospital says after a year of experience dealing with the difficult circumstances presented by the pandemic, the organization and its staff, although tired, are ready to deal with an anticipated influx of sicker patients.
“Wave one was where we were asked to ramp up and be ready for a significant increase in critical-care patients and yet that ended up being more of a long-term care tragedy,” said president and CEO Janice Skot.
“Wave two and wave three are absolutely about critical care," she added. “Patients are getting sick faster, longer, and they’re younger and they’re in our intensive care unit."
RVH's critical-care capacity plan sees a more than doubling of capacity in that unit, increasing from 16 beds up to 37, seven of which opened on Friday.
Skot said the hospital is well-equipped with personal protective equipment (PPE) and other vital equipment that was a concern during the early months of the pandemic.
“We’re very ready for the critical-care issues that we’re facing,” she said.
Of the 25 COVID patients at RVH as of Monday, eight were in critical care, five of whom were on ventilators.
The challenge has become staffing as hospitals across the country continue to increase recruiting efforts to meet the ongoing demand presented by the pandemic.
Friday’s directive from the province to ramp down scheduled procedures frees up some staff who can turn their attention to the sick COVID patients to create that much-needed critical-care capacity.
On Monday, the cases of 33 surgical patients were cancelled and, so far, 146 surgeries have been called off over the week. Skot said that's difficult for those who had a scheduled surgery, but the skill set being used in those operations were considered important to the current effort in treating those sick with COVID.
“Our OR (operating room) staff are some of our most highly trained experts in that field, so we needed to make sure that we have them available to deal with what we’re anticipating will be a significant increase in critical-care demand,” she said.
The result, however, is that a pre-existing backlog of approximately 2,500 surgeries created earlier in the pandemic will continue to build, meaning those patients will have to wait months before their surgeries can be rescheduled.
Although staff are monitoring those 'non-urgent' cases in case they progress and become urgent requiring immediate attention.
The Barrie hospital continues to run a limited operating capacity for emergency cases, trauma and vital cancer surgeries as occurred during the first wave of the pandemic.
Friday’s provincial emergency order also allows hospitals to transfer patients without their consent to other hospitals.
In recent months, RVH has accepted some of the overflow from overtaxed hospitals in the Greater Toronto Area. So far, 124 patients have been moved to the Barrie hospital from the GTA for treatment. Of those, 18 were cared for in the RVH intensive care unit. And of that total, 21 have arrived since Friday’s directive.
Skot said the patients from the GTA are arriving daily.
The RVH pandemic response unit (PRU), or field hospital erected in its parking lot, continues to operate, taking in non-COVID patients from the region to free up space in other Simcoe-Muskoka hospitals.
The challenge there, too, is staffing, Skot said.
On Monday, 19 patients were receiving care in the PRU. It is currently staffed to take care of 22 patients, but there is potential to boost occupancy to 70 beds if staffing and resources allowed, said Skot.
“It’s been difficult. Everyone is trying to recruit health-care resources,” she said. “We’ve done what we could to get recruitment up. We can now operate about a third of the PRU and we’re continuing to recruit into it as well.”
Meanwhile, the hospital’s overall capacity of 83 per cent leaves that 15 per cent capacity availability required by the province to accommodate demands presented during the pandemic.
RVH has 26 beds at the IOOF campus in the Allandale neighbourhood, largely accommodating alternate level of care patients working toward discharge. During the pandemic, the Barrie hospital also received funding for an additional 30 beds within the facility.
Currently, that adds up to a total of 408 beds with additional surge spaces of 40 beds used when required.
All that means that the facility has moved away from “hallway medicine” when capacity exceeded 100 per cent and patients were left in hallways to be cared for prior to the pandemic.
“We can’t go back to hallway medicine again. We’ve been able to keep patients out of hallways and this is the safe way — we’ve always known that — to care for patients. But certainly this pandemic has taught us that in an important way,” said Skot.
Given the challenges presented by the pandemic, Skot said the hospital and its staff are still able to care for people who need medical attention and stressed that the emergency room is still available to those who need it.
“Our emergency department remains open 24/7 and if you have any issues in the public, you need to come to our emergency department. We don’t want people to stay away,” she said.
The latest urgency with pressures on intensive care beds across the province comes after a year of pandemic operation at the hospital. Skot said RVH has been planning, is well-organized and has “a tremendous amount of experience” now to deal with an influx in the third wave.