COVID creating ICU overflow, cancelled surgeries at Red Deer Regional Hospital

“We need people to know the hospital is under stress and that we need people to take COVID seriously,” urged Dr. Kym Jim, nephrologist and internal medicine specialist.

“The hospital is still a safe place. There are extreme measures put in place to ensure that. Everyone from administrators to healthcare workers is working to ensure that. But people need to be aware that there are problems out there.”

ICU overflowing…

The Intensive Care Unit at Red Deer Regional is running at 200 per cent capacity.

“We are busier than we’ve ever been. We’ve had more people in the ICU than during H1N1,” says Dr. Luc Benoit, ICU physician. “That includes a lot of COVID patients and also other patients.”

Benoit notes, “ICUs are typically full, that’s just normal, especially in the winter time. COVID definitely has increased the demand for ICU admissions. This would be beyond a ‘busy winter.’”

There were 38 COVID-19 positive patients admitted at Red Deer Regional as of Thursday morning, AHS reported, including 17 in intensive care.

“We can still look after someone properly,” Benoit said, “but there are only so many tricks we can pull off in order to look after more ICU patients. We frankly would have to shut down other components of the hospital to take their physical space, staff or equipment.”

“I definitely don’t want to slow down the surgeons at all. If someone needs a surgery today, they’re still going to need it next week if we cancel it. If anything it just becomes more complicated or difficult for the surgeon if there’s a delay.”

The hospital’s ICU has 12 beds, with another six Coronary Care Unit (CCU) beds that can, and currently do, support critically ill patients who require a ventilator. The hospital can expand to 27 critical care beds if necessary to accommodate additional patients requiring a ventilator.

Red Deer Regional is the lone hospital in the AHS Central Zone, which has over 400,000 people, with ICU beds dedicated to COVID patients.

Surgeries delayed…

Starting last week, scheduled non-cancer surgeries (e.g., knee replacements, hernia repairs, gall bladder removals) at the hospital are being cancelled.

AHS said on Dec. 31 that 12 surgeries had been cancelled for the week of Jan. 4-8, but Wolstenholme says it’ll end up being more.

“A decision was made after those numbers were released that we should shut down at least one operating room per day and some of the other operating rooms would run at 50 per cent capacity,” he explained.

“At minimum you’re looking at probably six surgeries per day that are being cancelled. Instead of 12 per week it’s probably going to be more like 30.”

Wolstenholme says the surgeries they are doing are taking longer due to COVID-19 measures.

“Normally you would do the surgery in the operating room and then you would take the patient to the recovery room. But with all these patients under COVID precautions we can’t do that now because we can’t risk exposing the other patients. So instead that patient has to recover in the operating room, which means you can’t use that space to do the next surgery.

“Unfortunately our efficiency has dropped significantly, not because anyone is being lazy, it’s just the reality of the situation,” he laments.

Wolstenholme says they’re still trying to dig out of a backlog of surgeries from before the pandemic, and that it’s scary to think about the kind of wait times they’ll be facing when it’s over.

“The trickle-down effect to the rest of the healthcare system is really significant. We’re feeling it now and will well into the future.”

Emergency…

In spite of the pressures presented by the rising number of COVID-19 admissions, doctors say people with medical issues need to continue coming to the hospital for the treatment they need.

Dr. Mark Weldon, a physician in the hospital’s Emergency Department (ED), says there’s been a concerning 25 per cent drop in ED visits during the pandemic.

“If you think you’re having an emergency, don’t stay at home. We’re open. If you need care right away, you’ll still get it,” he urges.

“If you had chest pains, for example, I would rather you come and let me tell you it’s nothing opposed to you deciding for yourself that it’s nothing. It’s easy for us to see someone, then discharge them.”

Weldon said they were hitting a “pretty high level” of admitted patients on Wednesday but were still able to see the remaining arrivals.

“We know there are increased deaths and undiagnosed cancers occurring as a result of people not seeking medical attention,” said Dr. Jim. “The hospital is a safe place they need to come to for medical attention. That’s very vital for people through all of this.”

AHS measures…

“AHS continues to implement COVID-19 pandemic response measures at RDRHC to ensure the site continues to have capacity for those who need it,” explained AHS spokesperson Heather Kipling.

“We can increase to 27 critical care beds if necessary, by converting patient spaces that are traditionally used for one bed to accommodate two. We can also add transitional beds for the most stable ICU patients on our specialized cardiac and telemetry care unit.”

Kipling acknowledged that demand is also high outside of the ICU, and they are experiencing challenges in admitting patients from the Emergency Department, as well as ensuring there is space available for surgical patients who need care post-surgery.

“We are also utilizing patient spaces within the Medical Specialty Clinics to temporarily care for ED patients awaiting admission during times of greatest need. We are able to use this space without impacting the services provided by the Medical Specialty Clinics as they are currently providing services virtually for patients. We are also able to utilize the Medical Specialty Clinic to support extended hours of the Minor Treatment Area of the ED to help see patients as quickly as possible.”

Kipling says they are also working to secure additional staffing supports in areas of greatest need.

“Such efforts are in addition to a number of other temporary measures that have been implemented to help mitigate the pressures, including working with rural sites across the Central Zone to transfer patients who don’t require the specialized care RDRHC provides, discharging patients who can safely return home with Home Care or family supports in place, or transferring such patients to other sites within the zone while they wait for placement in continuing care.”

Lower COVID numbers needed…

Doctors say it’ll take citizens staying vigilant and not letting their guard down when it comes to COVID-19 for there to be any real improvement with the situation at Red Deer Regional Hospital.

“COVID is active in central Alberta and the activity level in the community is having an effect on the functions of the hospital and has put it under tremendous stress,” Jim warns. “Right now things are at a fever pitch and manageable with good plans in place. But that is not to say that we wouldn’t be close to having significant problems if these kinds of rates to continue.”

He adds, “We’re very concerned overall that we need to keep COVID controlled in the community so that we can have a hospital that can provide all of the other services for people that need them, including surgeries.”

“I get the feeling that’s out there that (because) the numbers are dropping a little bit, people are dropping their guard a little bit thinking the worst is over, but it certainly doesn’t feel like that here. I don’t think we’re near anywhere out of the woods yet,” said Wolstenholme.

“I don’t know where the breaking point is. I’m not sure anyone can be certain,” Benoit pondered.

“You could see a subjective drop in the quality of how well you look after a person at a certain point. I don’t think we’re there now. But it’s hard to say where that point is because you may only be able to tell in hindsight. I hope we’re still a ways away, but we’re in uncharted waters.”

by Troy Gillard

COVID creating ICU overflow, cancelled surgeries at Red Deer Regional Hospital

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