Healthcare advances and cuts are causing crisis in Canadian children’s hospitals

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Second intensive care unit. heated trailer Outside the emergency room to handle unrequited love for sick children. A message to physicians that an agency that protects them from malpractice accusations is “be there for you” if you are referred for care outside the normal range.

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Unprecedented overcrowding in children’s hospitals across the country has been dubbed the worst pediatric health crisis in history.

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It wasn’t sudden. For years, there has been a call to right-size the health care system for children who were too young before COVID-19. In 2018, one year before SARS-CoV-2 hit the world, seriously ill babies and toddlers in need of her empty ICU beds were shipped across Ontario “like Amazon luggage.” it was done. Alex Munter, the director of Children’s Hospital in Eastern Ontario recently tweeted. In the same year, only 65% ​​of children’s “elective” surgeries were completed inside a window considered safe. Today, it’s nearly halved due to more surgeries being postponed due to COVID.

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how did we get here

Part of the reason is the wonders of modern medicine. Overwhelming as this system may be, for decades science has triumphed – defeating disease and allowing babies who once could not survive to be bundled up and sent home. made it possible.

Advances in surgical technology have allowed surgeries that used to require overnight hospital stays to now allow children to go home within hours. Innovative treatments have shortened hospital stays. The kids are better off, the system is better, and the parents are happier. This is the good news that underlies the medical revolution, but equally embedded in the story is the conscious decision to reduce the number of hospital beds for children, giving them the same need. I was convinced it wasn’t.

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This was a risky calculation. Babies born very preterm or with neurological conditions can beat the odds and go home, so future medical needs could be significant. Sometimes we need a bed, but in this desperate time we don’t have one.

“These are not perfectly healthy kids right now,” said Dr. Beth Foster, chief pediatrician at Children’s Hospital of Montreal. “They still need a lot of care.”

There are other looming cracks in the facade. The number of school-age children with moderate-to-severe chronic diseases such as asthma, diabetes, kidney disease and obesity has increased in the last few decades. children’s ER visits had already increased. Today, hospitalized children are more ill, stay longer in hospital and require more specialists to care for them. Then came a duplicate virus and a national shortage of Tylenol for children, unleashing a system that had previously shrank capacity, cut staff and closed beds.

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Ottawa’s CHEO has less than half the number of beds it had when it opened in 1974, but the city’s child and youth population is growing nine times faster than the state average, Munter said. This is the moment when aging healthcare workers, burned out by the pandemic that has entered its third winter, are retiring early or leaving the profession. There is no Slack built into the system and it is currently being tested by the full Storm.

How to right size the system?

It’s not just about money. Dr. Ronald Cohn, president and CEO of SickKids, says what is needed is a system lens approach. Where does the new targeted investment really need to be made, he said—specialized pediatric hospitals? Community hospitals, where most children in Canada are found outside metropolitan areas? Primary care? — “For changing some of the models of care we have practiced for decades.”

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Children are sent through a range of primary care, from community hospitals that can handle eustachian tubes, tonsillectomies and appendectomies, to large, expensive high-tech referral hospitals like SickKids that do heart surgery, transplants and surgeries. lives in the care of For brain tumors and solid organ tumors. Create a seamless connection between all of these. “Then I think this can be resolved,” she says Cohn.

Decades of poor planning have led to a shortage of well-trained nurses. Canada lost elderly nurses and other health workers who were already nearing breaking point before COVID hit. However, the crisis of medical personnel has been talked about for 30 years. Foster said it shouldn’t come as a surprise to anyone.

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“We need to train more nurses, train more doctors, and lower the barriers to entry for doctors from other countries,” Foster said. should be placed in the

Foster and other medical leaders and children’s advocates are calling on federal and provincial governments to secure funding for children’s health care and provide better data on the health of children in Canada. Collect and appoint a commissioner for children.

“This is what the grown-up side has been living with for years,” he had me say. People on stretchers in emergency rooms wait days for beds. It’s true,” Foster said. “But do we really want that to be the standard? Do we really want to say, ‘It’s bad for adults, so let’s make kids do it too’?”

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In a previous interview with The National Post, Dr. Stephen Friedman said that in the short term, it helps parents keep their children from contracting viral infections.

“Encourage people to wear masks when necessary and avoid going to friends or school when sick. There are very few signs,” said Friedman, an emergency physician at Calgary’s Alberta Children’s Hospital.

Immunization “is our greatest defense at the moment, independent of masking and surrounding diseases,” he said.

Parents can use local resources to determine if their child needs to be taken to the emergency department, he said.

“Also use your doctor, primary care provider, and pediatrician as a resource, especially for chronic complaints,” Friedman added. If you come to the ER with , it takes a very long time to see a doctor. We really focus on people who need urgent care.”