Pediatric pressures highlight need for right sizing of child & youth health system

McMaster Children’s Hospital is doing everything possible to care for more children and youth than ever before, largely because of a surge in respiratory viruses.

It is important to note, however, that McMaster Children’s Hospital – one of only five pediatric hospitals in the province – reached a tipping point long before this fall. We serve the fastest growing pediatric population in Ontario and are the second largest pediatric hospital by inpatient service volume after Sick Kids. This was the case prior to the significant viral surge of the past many months and it will remain that way after it subsides. The hospital needs urgent investment, even expansion.

Even before the viral surge and the COVID-19 pandemic, kids across the province were waiting far too long for vital pediatric services, with many waiting beyond clinically recommended targets and some waiting longer then adults for surgery and diagnostic imaging.

The crowding of our emergency department (ED) is troubling. We are routinely providing emergency-level care for children in hallways and spaces normally used for other healthcare services, such as surgery, diagnostic imaging or mental health assessment. When this happens, those services are stalled and wait times get longer.

When patients need to be admitted, they end up waiting hours, and in extreme cases up to 24 hours, in the ED for an inpatient bed. Some days, there have been more than 20 young patients waiting for a bed because the occupancy rate at McMaster Children’s Hospital is persistently more than 100% and has been as high as 140%.

The pandemic has worsened the situation. McMaster Children’s Hospital has an estimated backlog of 2,332 pediatric surgeries. Over 58% of kids on the waiting list have already exceeded the clinically recommended wait time targets for spinal surgery, cleft lip and palate surgery, and surgery to address obstructive sleep disorders.

The hospital’s Developmental Pediatrics and Rehabilitation program has 1,500 children waiting to see a specialist for diagnosis and treatment of things like neurodevelopmental disorders, genetic diseases and disorders, and fetal alcohol syndrome.  Approximately 1,200 new children are added to this list every year and the problem will only continue to grow. Current resources can only support care for 750 children annually, which means the wait list will increase by an additional 450 children every year. Many of these children are already waiting two years or more, and are likely to miss key developmental milestones, with lifelong implications.

Children’s Healthcare Canada, along with the Canadian Paediatric Society and the Canadian Association of Paediatric Nurses say that Canada’s eight million children and youth are now facing a healthcare crisis. Together, they are calling on all levels of government to move beyond jurisdictional constraints, and work collaboratively to provide new funding to grow services, secure the needed health human resources, and scale up infrastructure to “right-size” child and youth healthcare systems.

Careful planning and investment by all levels of government is needed to ensure the resources devoted to child and youth health are sufficient to meet population growth and address the service backlog of the past two years.

We have received modest but important investments over the past decade to increase capacity here in Hamilton. Most recently, the Government of Ontario provided permanent funding for two Level-3 intensive care unit beds, and four Level-2 intensive care unit beds. Given our growth and significance in Ontario, McMaster Children’s Hospital should be at the top of the list for additional growth funding in the very near future.

Thank you to our patients and families for your patience and understanding. Thank you as well to all our staff, doctors, learners and volunteers for doing everything you can to support children and families every day, and particularly during this very trying time.

Everyone is encouraged to:

• Wear a mask in crowded indoor spaces, including schools
• Stay home when sick
• Wash your hands frequently
• Get all the vaccines you are eligible for, including COVID-19 and flu
• Know your health-care options. You can visit your family doctor for health concerns that can wait a day or more; contact Health Connect Ontario to speak with a registered nurse 24/7 via phone at 8-1-1 or web chat; or visit an urgent care centre for health concerns that are not life-threatening but can’t wait for a doctor’s appointment. There are also two Flu, COVID and Cold Clinics in Hamilton – one at McMaster Children’s Hospital for children and youth, and one at Joseph’s Healthcare Hamilton West 5th Campus. Visit needadoc.cato learn more.

 

Bruce Squires, President, Hamilton Health Sciences’ McMaster Children’s Hospital

Dr. Angelo Mikrogianakis, Chief of Pediatrics, Hamilton Health Sciences’ McMaster Children’s Hospital and Chair of Pediatrics, Faculty of Health Sciences, McMaster University