I apologize to everyone I could not individually reply to. So a brief thread about ICU capacity, as it pertains to Edmonton in the time of #COVID19.
Edmonton’s General ICU beds are spread out amongst all of its hospitals. We have two major trauma centres situated at the University Hospital and Royal Alexandra Hospital. The Sturgeon, Grey Nuns and Misericordia handle both surgical and medical disease.
The university also has the Mazinkowski which manages heart surgery and ECMO, and a neurosurgical ICU. The RAH has multiple step down units, both surgical and medical that can act provide high level care.
ICU beds are limited resources and expensive to run. They require specialized staffing with multidisciplinary teams. A bed is really just a term that encompasses how much service we can provide. You need to be efficient in their use, and so things move fast.
Surprisingly, ICU admission rates follow very predictable patterns. We see more trauma in summer, but this is offset by fewer elective surgeries. Numbers in the fall climb because of influenza and endemic viral pneumonia’s. Our staffing and bed utilization is prepared for this.
#COVID19 has really changed most of this. Our ORs are up and running trying to catch up to the backlogged elective surgeries that accrued during the lockdown when the ORs were closed. That has increased our numbers.
We have seen a significant increases in trauma. Some of this is just a return to previous lifestyles and poor decision making, but much of it is amplified by huge increases in substance use. Wether this is driven by COVID related mental health issues is not for me to say.
We are seeing more ICU admissions from COVID pneumonia’s. This in itself is not overwhelming the system, but these patients remove beds from the system for months, while our average patient length of stay is about 5 days.
Anyone sick enough to end up on a ventilator has multisystem disease. While we can manage the renal failure, pneumonia and liver disease as separate issues the culmination of all these problems on top of the horrible delirium is what keeps them in the unit for so long.
We have contingency plans as we run out of space, but they all involve reducing the general level of expertise to the entire population of ICU patients. My ICU has 11 intensive care physicians in total, and a finite number of specially trained nurses.
We have a theroretical maximum number of “beds” but as we grow we drain resources from other hospital services. We take over recovery rooms closing ORs and borrow staff from gastroscopy and angiogram suites making it harder to get heart and stomach procedures done.
Many aspects of critical illness are beyond our control, but many are. Use substances responsibly, and don’t drive or ATV under the influence. Get your flu shot. Wear your seatbelt. Support social services and harm reduction.
And please, do not gather in large groups. Live your best life once you get the Covid vaccine. Until then keep you distance, wash your, hands, be a good citizen and want to wear your mask. Give us room to breath so we can help you breath too. We are so close.
