Canada’s pediatric hospitals and the doctors who work in them are raising concerns about the spike in sick kids filling up emergency rooms and hospital beds amid the current respiratory season. Some are urging parents to keep their kids at home, depending on what symptoms they are showing.
In just the past week, health officials in Alberta and Quebec have noted capacity issues at their hospitals, with the president of the Alberta Medical Association, Dr. Paul Parks, saying there were “a lot of kids being hospitalized.” Parks says their hospitals are overflowing at 150-per cent capacity, with ICUs almost full
This week, Ontario Hospital Association President Anthony Dale said in a news release that the province’s facilities are seeing evidence of COVID-19, RSV and the flu creating a surge, with occupancy in the province sitting at 97.8 per cent and intensive care at 75.8 per cent as of Dec. 3. In addition, as of Nov. 30 Dale said that pediatric ICU occupancy was at 76 per cent.
With many hospitals facing this crunch, some doctors say there are certain illnesses parents can keep an eye out for when determining if they should take their child into the ER.
“A simple fever where a child’s active and drinking is not necessarily a reason to come to the emergency department,” Dr. Laurie Plotnick, medical director of the pediatric emergency department at the Montreal Children’s Hospital told reporters last week.
“If a child is having trouble breathing, if they seem dehydrated so they’re not urinating, they’re much more lethargic than usual, they’re not drinking, they’ve had a fever that’s persisted for a long time, they need to see a health-care professional.”
She adds a serious head injury or something that may seem like a fracture are also cause for emergency care.
From Nov. 17 to Dec. 1, minor health problems reportedly accounted for 58 per cent of ER visits at Montreal Children’s Hospital and 37 per cent at Sainte-Justine.
While hospitals are facing strain, Edmonton emergency physician Dr. Louis Hugo Francescutti told Global News in an interview that parents should still trust their own comfort levels.
“When you’re not feeling comfortable, bring your child in because you know your child better than anyone,” he said. “And if your comfort level isn’t there, maybe we can help you develop a comfort level and provide you support.”
When a family comes into hospitals, however, once they are assessed by a nurse on initial entry the patient may have to wait longer based on a facility’s triage system — a system of medical priority Plotnick notes determines how urgent care is needed as opposed to when the child entered the hospital.
Dr. Antonio D’Angelo, head of emergency at Sainte-Justine hospital in Montreal who joined Plotnick at last week’s press conference, told reporters the triage nurses are usually the most experienced in ERs and know when a patient is sick and requires urgent care, and when patients can wait.
“Most patients that are waiting a long period of time usually don’t even need to be in the emergency department,” he said. “If they’re waiting very long, usually it’s because they should have gone to see a clinic.”
Wait times range from province to territory, with some like Ontario seeing an average two-hour wait between triage and being seen by a doctor — though some hospitals like the Children’s Hospital of Eastern Ontario (CHEO) having an average four-hour wait — while hospitals in Prince Edward Island averaging around four to five hours but the Queen Elizabeth Hospital seeing a current wait time of about eight to nine hours. Depending on the hospital in B.C., some have a wait as low as 1.5 hours, with BC Children’s Hospital sitting at about two hours 42 minutes.
If parents are unsure whether to take their child in, there are various options. the BC Children’s Hospital recommends going to a family doctor, walk-in clinic or urgent and primary care centre, if available. Similar recommendations were made by Plotnick and D’Angelo, noting the 811 health hotline is also a tool, a number used in all provinces and territories as an often-24/7 healthline.
BC Children’s Hospital also told Global News in a statement that it has not seen a significant and sustained increase of serious respiratory illness cases to its emergency department, with the average volume typical for this time of year. However, it noted if an increase were to happen, the hospital was prepared to make adjustments as needed.
Francescutti said while he recognizes most of the time kids will be OK, it is never the wrong choice to take your child into the emergency department if you’re concerned. While he acknowledges an ideal system would see every Canadian with a primary care provider, at the same time during after-hours those safe medical professionals would suggest going to the emergency department.
“The emergency department’s going to be operating whether those kids come or not, you know, the infrastructure and the staff are in place,” Francescutti said. “If it’s busy and you have to wait, well, that’s busy and you have to wait.
“But, you know, most triage nurses are really good … And then a lot of them (families) will turn around right at the desk without making a chart. So it’s always best to err on the side of caution for kids.”
Dr. Melissa Langevin, pediatric emergency physician at Children’s Hospital of Eastern Ontario (CHEO) and the department’s associate director, said in an interview with Global News that if parents are unsure about taking their child into the ER because they see wait times at 10 hours or even 13 hours, the thing they should do is just come in.
“If you’re worried about your child and if you think like my child is really unwell, don’t look at the wait times. Just come and see us,” she said. “That’s a really important messaging, that the time that you see on the website is not everybody’s wait time, it’s the time for people who have been assessed by a triage nurse … who’ve been triaged to say ‘yeah, you’re uncomfortable, we’ve managed your fever or your pain,’ and now there is a safe waiting period that can happen.”
Langevin said with the holidays approaching, one thing parents can also do to make a difference is to get children their flu shot and, if needed, a COVID-19 booster shot. She said CHEO is seeing an uptick of flu in the last two weeks with symptoms lasting between four to seven days, including prolonged fevers.
“Kids and entire families are involved because generally one of the kids is sick and everyone will get sick,” she said.
“The last thing you want is the entire family with flu on Christmas Eve.”
— with files from Global News’ Carolyn Kury de Castillo, Kalina Laframboise and Tim Sargeant