The worst is still preventable in hospitals

No one wants to triage patients when the network is overloaded. An expert in the triage protocol for access to intensive care puts forward several proposals before arriving there.

The triage protocol for access to intensive care is ready to be applied should hospitals become saturated with the Omicron wave. Its instigators believe, however, that several solutions can still be considered to avoid the worst, including the designation of hospitals entirely intended for patients with COVID.

On Wednesday evening, the members of the national prioritization committee for access to intensive care met to ensure the most efficient procedure to implement this protocol intended, if necessary, to determine who will have priority access to care. intensive in the event of over-saturation of hospitals.

“The plan had already been updated this fall. All we hope is that we don’t have to apply it. It never has been until now. The same criteria as in 2020 prevail, but an update has been made to clarify how to manage inequalities clinically. The aim of this protocol is to identify, with appropriate clinical and ethical criteria, the patients who have the best chances of survival, ”explains Dr.r Joseph Dahine.

Normally, this protocol should be triggered only if hospitals reach 200% of their capacity, predicts the Ministry of Health. Currently, the total number of beds for patients with COVID is estimated to be around 800-900 beds, and 55% are already full. In theory, it would take 1600 to 1800 hospitalizations for the capacity of the network to be exceeded.

“We can see that the pressure is mounting, and this, because we still have COVID patients in intensive care who have been there since last September. A third of our resources are already mobilized by these “old” cases of COVID ”, explains Dr Dahine, intensivist and co-editor of the national intensive care triage protocol.

At a time when the Omicron wave hits the employees of the health network head-on, he wonders about the real number of beds that may be available in the event of a marked increase in hospitalizations in the days to come. As of December 23, as many as 5,185 employees were absent due to COVID-19, and that number is likely to increase, he believes.

“The variant is so contagious that we will have to look at other options if we are sorely lacking in staff. Why not assign full hospitals to COVID patients? », Says Dr Dahine.

This strategy would limit outbreaks and protect the ability of other hospitals to provide alternative care, avoiding contact between “cold” and “hot” patients, and between asymptomatic infected employees and others.

“There are so many employees in segregation. Every day, new colleagues who are doctors, nurses or other professionals who are completely asymptomatic are tested positive. It just keeps going up. This approach would allow hundreds of asymptomatic employees to return to work with infected patients, in hospitals serving COVID patients, ”he said.

Explosion in the number of absentees

According to figures from the National Institute of Public Health of Quebec, on December 22, there were 113 active outbreaks in care and living environments in Quebec. An increase of almost 300% in one month.

In Montreal, nearly 2,000 employees are isolated at home, either because they are infected (666), or in preventive absence (643) or in the screening process (382), according to figures compiled on December 23 by the ministry. of Health and Social Services (MSSS). The count is increasing day by day. In 24 hours, 151 more employees were tested positive for COVID in the metropolis on Thursday, and 350 more employees are being screened.

According to the intensivist from Cité-de-la-Santé in Laval, the hot and cold areas of several hospitals were dismantled this summer due to the drop in the number of COVID patients, so that asymptomatic staff infected with the contagious Omicron variant, can now switch from a “hot” patient to a “cold” patient, increasing the risk of an outbreak.

“There is a deep reflection to be done to have establishments better equipped to face this crisis. Logistics and infection prevention issues remain with COVID zones, ”he believes.

The Prioritization Committee for access to intensive care also stressed to MSSS representatives the importance of planning corridors now to transfer patients from one region to another. Because if the Omicron variant is also contagious for everyone, regions and hospitals will be more affected than others, it is expected. “The impact on hospitals is going to be asymmetric, so patients in a region should not be hit because their emergency is overflowing. We did simulations to ensure that the patients were better distributed, ”he says.

Of the 24 new hospitalizations (excluding intensive care) identified Thursday, 16 were in the greater Montreal area. Two of the three new intensive care admissions were in Montérégie.

According to the Dr Dahine, these few possible solutions could be implemented in the short term to increase hospital capacity. The return to work of infected but asymptomatic doctors and caregivers is one of them. “These people are even disappointed and worried about leaving their colleagues on the sidelines in the midst of a crisis,” he says.

This solution has, however, been denounced by the Federation of Health and Social Services (FSSS-CSN) which fears that the return of infected employees to “administrative tasks” or to COVID patients may unduly increase the risk of infection. other employees.

One thing is certain, insists the Dr Dahine, the government must have convinced that the maximum has been done to increase the number of available beds before initiating the triage protocol for access to critical care.

While waiting for the anticipated wave, emergency and intensive care personnel were holding their breath on this strange pandemic Christmas Eve. “There is a funny feeling here,” says the D.r Dahine. There is something unusual and unusually quiet about our services. The stress is palpable. The feeling is strangely similar to that of March 2020. “

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