“It’s a perfect storm”: How pediatric hospitals are dealing with overcrowding, long wait times and staffing shortages

“It’s a perfect storm”: How pediatric hospitals are dealing with overcrowding, long wait times and staffing shortages

A Q&A with Dr. Jason Fischer, head of emergency medicine at SickKids

Photograph by Sierra Nallo

Children’s hospitals are facing an unprecedented number of stressors this fall: a surge in respiratory illnesses, overcrowding, long wait times, staffing issues and a children’s Tylenol shortage. As Ontario’s top doctor urges people to mask up, we spoke to Dr. Jason Fischer, head of emergency medicine at SickKids, about the current crisis in pediatric care.

You’re dealing with countless pressures right now. How did things get so bad?
This year has been a perfect storm. The overcrowding issue in our emergency department has been compounded by ongoing issues with access to primary care. Families just can’t see their doctors in a timely way. There’s also the shortage of liquid Tylenol and ibuprofen, so parents can’t effectively manage their children’s fevers at home. And then we have staffing shortages across the health care system, especially with nurses. Now our staff members are becoming sick, adding even more pressure. The final factor in this storm is that many families haven’t had a sick child for two years—if ever, for the youngest kids. These families are desperate for reassurance that their child is going to be all right, leading to more kids being brought into the emergency room.

What kinds of illnesses are they coming in with?
We’re seeing a surge in respiratory syncytial virus (RSV) cases, alongside the common cold, the flu, and other viruses that we see every fall. Some of them have been emerging a bit earlier than usual this year. But it’s not RSV specifically that’s the issue—it’s the overall burden. We’re seeing typical seasonal viruses in the same age groups and with the same severity that we always would, but with a higher volume of kids.

What has that meant for crowding and wait times?
The pandemic played havoc with our volumes and number of arrivals because of lockdowns and everything else, but compared with 2019 we’re seeing about 25 per cent more patients for the same time frame. This translates into waits that are about three times longer—we’ve seen some wait times of 12 hours. The role of the emergency department is to always see the sickest and the most complex patients first, which means those with concerns that are traditionally managed by non-emergency health care are waiting longer. The health care system as a whole is relying too heavily on emergency departments. We can try our best to prepare for surges, but we can’t do everything.

How has the shortage of nurses contributed to this crisis?
It’s confirmed what we’ve always known: emergency medicine is a team effort. If you’re short physicians or nurses or any other part of the staff, then it’s very hard to deliver safe and high-quality care as efficiently and effectively as you would like.

It must be an intense time for the front-line workers who have stuck around.
Patients and families are frustrated with waiting. Sometimes, visitors take out their frustration on front-line providers—it’s not always civil. Front-line providers are all working so hard, and my biggest concern is that they’ll get burnt out because of all this frustration they’re dealing with. Now more than ever, we really need to support our front-line health care workers and show them how much we value their service. A smile, a kind word, or a thank you always helps.

Adult ICUs in Ontario will begin treating children ages 14 and up to help address the burden on the pediatric health care system. Does that bring hope?
It will definitely help the flow of patients through the emergency department. The health care resources within a city should be thought of as a single system, and all of them need to be optimized to help take care of kids. The emergency department is often a reflection of how well the system as a whole is operating. We’re working closely with community hospitals across the GTA to create the physical space necessary to deliver emergency care.

So, if I’m a parent whose child has a nasty cough, what can I do?
Families should be using online tools like AboutKidsHealth to learn about common symptoms like fever and cough so they can manage those symptoms at home and know when to seek care. SickKids’ virtual urgent care has a symptom checker that can help parents determine whether to seek emergency care right away or whether it’s okay to wait and see their primary care provider. They can even speak to one of our emergency physicians online. Families should connect with their doctors so they know what services are available in their communities. They can also contact local pharmacists to learn about alternatives to liquid and chewable Tylenol and ibuprofen until those products are restocked. It’s also very important for kids and everyone else to get vaccinated against the flu and Covid-19 to reduce the risk of serious illness.

Those family doctors can be hard to find.
Many primary care physicians are seeing patients with viral symptoms in person, but we’re hearing from our patients that not all of them are. We need them to join their colleagues in returning to in-person care and providing care when families need services. Sometimes that means working after hours.

If Doug Ford could grant you one wish, what would it be?
In the short term, the government needs to understand why families are coming to emergency departments and to make data-driven investments. We don’t have a very good understanding of why patients can’t access care in the GTA, so we need to figure that out first. In the long term, federal, provincial and local governments need to make investments in pediatric care. This situation shows how critical it is that we fund our human resources, not only our infrastructure. We don’t value people enough—you can’t just turn a nurse on and off. It takes time for them to develop their expertise.

Should we brace ourselves for a bad winter?
We’re preparing for the viral season to continue and for our volumes to increase. We’re optimistic that we can handle it because we saw how the health care system was able to respond to the needs of patients and families during the pandemic. I believe we can provide the necessary care, but we’re definitely going to see more patients before the numbers decrease again.