Keeping health-care workers healthy critical to hospital plan By: Tom Brodbeck Posted: 7:00 PM CST Friday, Nov. 6, 2020

Manitoba’s health-care system may have the hospital space, equipment and supplies to handle a large influx of COVID-19 patients. What may be missing is an adequate supply of qualified staff to handle the load, especially if there’s a sharp rise in pandemic-related absenteeism.

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Hey there, time traveller!
This article was published 05/11/2020 (1511 days ago), so information in it may no longer be current.

Provincial chief nursing officer Lanette Siragusa provided more details Friday of Manitoba’s three-phase plan to expand hospitals, should COVID-19 patient volumes exceed existing capacity. The plan, first announced last week, would see hospitals use surplus space to open more beds and reassign surgical teams to help staff them. Low-acuity, non-COVID-19 patients could be moved off-site in a worse-case scenario.

Shared Health, which co-ordinates clinical care across the province, has beefed up its supply of medical equipment over the past few months, including the purchase of EKG monitors, infusion pumps and oxygen concentrators, said Siragusa. The province has nearly doubled its supply of mechanical ventilators.

Where it may run into problems is finding enough staff. It’s one thing to have the beds, the physical space and the medical equipment; it’s another to have enough trained medical practitioners to run those machines and treat acutely ill patients.

It’s one thing to have enough beds, space and medical equipment, it’s another to have enough trained medical practitioners to treat patients. (Ken Gigliotti / Winnipeg Free Press files)

Under the plan, hospitals have the capacity to increase medical beds by over 1,000 (and ICU beds by 143), said Siragusa. But what they don’t have are enough critical care nurses to maintain the standard one-to-one, nurse-to-patient ratio. Instead, ICU “teams” that include one critical care nurse and other allied professionals (such as physiotherapists and pharmacists) will be assembled to treat more than one patient at a time.

Also, about 100 community-based doctors have signed up to provide hospital support if required.

This plan could work if admission rates remain at moderate levels. But if the current COVID-19 trajectory continues, chief provincial public health officer Dr. Brent Roussin said hospitals could be under “significant strain” by the end of the month.

The wild card in all this is infection rates among health-care staff. The more doctors, nurses and allied professionals that become infected and have to stay home, the more difficult it will be to implement this plan. There are no contingency plans if absenteeism explodes.

It’s not as if Manitoba can recruit from other provinces. Even provinces like New Brunswick and Nova Scotia (where infection rates are much lower than the rest of the country) are unlikley to share health-care staff. They know they could be in a similar situation within weeks.

”I’m not going to lie, it’s a challenge we face,” said Siragusa. “We are going to manage the best we can.”

All of this is made worse by staff shortages that existed prior to the pandemic. The province was still working out kinks in its hospital consolidation plan in the months leading up to the COVID-19 outbreak. That included going from six acute care hospitals to three in Winnipeg and converting the rest to urgent care centres.

Even prior to the pandemic, doctors and nurses complained intensive care units were not adequately resourced.

Shared Health, which co-ordinates clinical care across the province, has beefed up its supply of medical equipment over the past few months, says provincial chief nursing officer Lanette Siragusa. (Mike Sudoma / Winnipeg Free Press)

Winnipeg hospitals are not yet overwhelmed with patients. As of Friday, ICU beds were at 94 per cent capacity and medical beds were at 80 per cent. Hospitals can move into Phase 2 of the expansion plan within a week, should patient volumes continue to climb. It would take “a few weeks” to move into Phase 3, where low-acuity patients are moved out of hospital, said Siragusa.

Meanwhile, this plan only works if there isn’t a rapid surge in patients. The province expects admissions to be incremental, allowing them to expand gradually. That may be optimistic, especially if seasonal influenza takes a foothold.

For the most part, the success or failure of this plan appears to hinge on how well health-care staff can avoid infection. With COVID-19 spreading in the community at the current rate, that’s going to be difficult to do.

tom.brodbeck@freepress.mb.ca