ICU triage protocol could be days away, warns nurses’ association

Registered nurse Jane Abas tends to a COVID-19 variant patient who is intubated and on a ventilator in the intensive care unit at the Humber River Hospital in Toronto, Tuesday, April 13, 2021.

Hospitals are doubling and tripling the usual number of patients handled by intensive care nurses as those sick with COVID-19 overwhelm ICU capacity, says the CEO of the Registered Nurses’ Association of Ontario (RNAO).

“It means that an ICU nurse cannot have the attentive eye as it should be over that one patient,” Doris Grinspun said.

“I have already heard directly from nurses that blame themselves because a patient died, ‘because if I could have been more with the patient maybe I would have saved him.’ Just picture when this becomes worse and worse and worse.”

An intensive care triage protocol — a guide for health-care professionals trying to decide which patients can access an ICU bed in a shortage — could be in effect as early as this weekend, Grinspun cautioned.

“I am very afraid of when they will start,” Grinspun said Tuesday.

Advocates have been raising concerns that the document would devalue Ontario residents with disabilities if health care is rationed.

Grinspun said she warned Premier Doug Ford last year — when Italy was going through its well-publicized COVID-19 crisis — that there was a need to train more ICU nurses and just opening a field hospital would not be enough if there were insufficient nurses to provide care.

“The difference between Italy and us is that in Italy it was naked to the eye,” she said. “Here, we are hiding it inside walls.”

An Ontario Ministry of Health statement said the government is adding thousands of hospital beds and ramping down elective surgeries to create more capacity in the system.

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  3. Head intensivist Dr. Ali Ghafouri, second left, meets with his health-care team doing his morning patient rounds in the intensive care unit at the Humber River Hospital in Toronto on Tuesday, April 13, 2021.

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“While the situation in our hospitals is concerning, no triage model has been activated in Ontario at this time,” the statement said. “Ontario Health and the Ontario Critical Care COVID Command Table continue to work with our hospitals to transfer patients from hospitals who are at capacity to other sites to ensure no capacity goes untapped.”

Ontario hospitals have 722 patients in ICU beds who have tested positive for COVID-19, and 537 on ventilators.

Public health officials have warned that hospitalizations will rise sharply over the next two weeks.

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