CCSO functions with a provincial perspective in partnership with health care providers, leaders, MOH and Ontario Health to ensure principles and elements of surge capacity management and the provincial structures for critical care are reinforced. CCSO’s tools and resources will continue to support this pandemic event.
COVID-19 and Critical Care in Ontario
With reports of COVID-19 significantly impacting critical care units around the globe, many partners across the province are planning within critical care units, hospitals and regions to be as prepared as possible.
CCSO is working closely with health system partners to leverage many of the programs and tools implemented through the Critical Care Strategy. In addition, CCSO will be sharing updates and new resources that will support inter-unit and inter-hospital pandemic planning efforts.
All content and media posted on the CCSO web site (in particular the Resources section) are shared for informational purposes only. CCSO does not endorse these documents and has made them available as potential resources for practitioners to use in conjunction with their clinical context and planning decisions that are taking place within their organizations.
CCSO COVID-19 Planning Activities
Critical Care Capacity
The experience for health care workers and health system leaders during SARS highlighted incomplete system-level understanding of what, and where, critical care resources existed and how silo functioning impeded the ability to identify and leverage resources across a region to improve access for patients.
The implementation of programs under the Critical Care Strategy and all subsequent programs supported by CCSO have at their core a focus on monitoring capacity and knowing where it exists and how to leverage this capacity across the system.
The increasing demand for critical care beds and resources to care for the volumes related to COVID-19 will be significant. A response to this is requiring local, regional and province-wide inputs, to leverage all capacity across all sites, ensuring core services can be maintained and that patients continue to have access to care.
Since 2009, CCSO has supported a provincial ventilator stockpile with over 200 additional ventilators available to hospitals across the province during times of capacity pressures. Additional resources have been made available to increase the number of ventilators in the provincial stockpile that can be used to meet demand in critical care capacity. These ventilators could potentially be used to care for critical care patients in non-traditional expanded physical space.
Data Analytics and Reporting
The ability to capture information on the COVID-19 status of patients admitted to Ontario critical care units through the Critical Care Information system (CCIS) will facilitate monitoring trends over time of COVID-19 in this patient population. CCSO also monitors ICU capacity pressures and resource utilization crucial to understanding critical care activity in regions and specific hospital sites.
CCSO has developed Provincial and Regional daily COVID-19 Adult, Paediatric, and Neonatal Critical Care dashboard. The dashboard, disseminated daily to our critical care stakeholders, is formatted to provide data analyzed according to previous LHIN boundaries and aggregate information for the corresponding five Ontario Health Regions. It provides hospitals, regions, provincial leadership, Critical Care Clinical Leads and the Ontario Critical Care COVID-19 Command Centre with information pertinent to COVID-19 activity in critical care units and informs responsive system planning to identify and address any emerging pressures in critical care capacity.
The timeliness and completeness of CCIS data entry is important to ensure timely and accurate data reporting required to identify system pressures and responding accordingly. Effective March 30, 2020, CCSO requests that each ICU complete LSI ventilation data for all patients in CCIS by 5:30 am. For example, all CCIS data for Monday, March 30th, 2020 is required to be entered in CCIS, fully and accurately, no later than 5:30 a.m. on March 31, 2020. Please refer to the memo disseminated by CCSO to all ICU leaders on March 30, 2020 for more information.
Find out more about the Critical Care Information System here.
CCIS Data Requests
CCIS data (including COVID-19 data) may be requested for research or non-research purposes as permitted under PHIPA. The request can be made by completing the appropriate data request forms (Research; non-Research) and submitted to the CritiCall Ontario Privacy Lead. All requests are reviewed by the CCIS Data Stewardship Committee.
Note: There is a COVID-19 Research Review Sub-Committee Expedited Review Process.
Planning Tables & Support by Provincial Critical Care Leads
CCSO leadership and members of Provincial Critical Care Leads and Provincial Critical Care Executive Committee (PCCEC) actively participate on a number of the provincial, regional and local pandemic planning committees. These include:
- Provincial Critical Care Command Table
- Ontario Critical Care COVID-19 Command Centre
- Provincial Ethics Committee
- Regional Planning Committees
The Provincial Critical Care Leads play an important system-level role regionally and locally to support and coordinate resources and planning during the COVID-19 pandemic.
- Erie St. Clair: Dr. Eli Malus
- South West: Dr. Ian Ball
- Waterloo Wellington: Dr. Francis Reinders
- Hamilton Niagara Haldimand Brant: Dr. Peter Kraus
- Central West: Dr. Mike Miletin
- Missisauga Halton: Dr. Janos Pataki
- Toronto Central: Dr. Niall D. Ferguson
- Central: Dr. Mike Sullivan
- Central East: Dr. Randy Wax
- South East: Dr. John Drover
- Champlain: Dr. David Neilipovitz
- North Simcoe Muskoka: Dr. Mark Bailey
- North East: Dr. Josée Thériault
- North West: Dr. Michael Scott
COVID-19 Related Human Resource Practices
Three major areas of focus have been identified as leading practices or innovations to be implemented for organizations during the pandemic to support staff.
Team Supports for Wellness including PPE
To provide staff with resources to improve mental well-being
Personal Protective Equipment Dashboards
Confirmation of PPE Supplies
Credit: Waterloo Wellington LHIN
Code Lavender: Assistance for Staff Dealing with a Stressful Situation
Assistance for staff dealing with a stressful situation
Credit: Unity Health Toronto
Health Human Resources – Alternate Models of Care
To provide senior leaders with resources to provide safe, efficient and transparent team based strategies during the pandemic
Staffing strategies and alternate models of care
Credit: Sunnybrook Health Sciences Centre
Pod model in critical care units.
As well as a guide to Support RN Roles and Responsibilities for acute care nurses with no prior ICU training and experience from medical surgical inpatient units to provide support when converted to the pod model.
Credit: Unity Health Toronto
Education and Upskilling
To provide staff with the opportunity for additional education for redeployment and/or upskilling
Centralized Critical Care Modules to Support Upskilling and Education
Module to support upskilling and education
Credit: Unity Health Toronto
Critical Care Educator
A dedicated critical care educator to provide an in-house critical care course.
Credit: Southlake Regional Hospital
To celebrate and give a voice to the invaluable work that critical care teams are doing each and every day, CCSO created this participatory project for the Ontario critical care community to tell their story, displaying a collection of reflections submitted during the COVID-19 response.
Stories create community, enable us to see through the eyes of other people, and open us to the claims of othersPeter Forbes, photographer and author
July 8, 2020
In times of grief and pain, we have stepped in to act as not just care providers, but family.ICU Manager, Sarnia
June 9, 2020
Thinking Outside the Box
While we haven’t physically met, we’ve fostered unforgettable interprofessional teamwork and reminded each other how much we care for patients.Interprofessional Task Force, Scarborough
June 8, 2020
Lesson to be Grateful
COVID made me realize how we take our loved ones and our good health, for granted.Toronto
June 5, 2020
Trying to Find Balance
Wake up, make coffee and open laptop. Now it is dark. Have I showered? Time to return to sleep.Analyst, Toronto
June 3, 2020
I WILL reassure you, your family, my colleagues, my own family, my friends….. it’ll be ok. Be brave.ICU RN, Oakville
June 2, 2020
The successes we experienced are rooted in TRUST of our healthcare experts and clinicians; for without we would have failed.ICU Manager, Mississauga
June 2, 2020
Being used as ‘instruments by God’ in the fight against COVID.RN, Markham and Scarborough
June 1, 2020
T and T
Trials and tribulations – who knew the effect that not having family in would have? Skepticism, distrust, anger, disconnection, misunderstanding……how do these affect our patient and the therapeutic team?Social Worker, Hamilton
May 27, 2020
My ICU Family Supported Me
I became COVID positive and was quarantined and at home for 7 weeks. My ICU family sent me daily doses of love to help me stay positive, won’t ever forget!RN, Oakville
May 27, 2020
Patient says, “NO to mechanical ventilation, I’m ready.” Then dies on my watch. My heart is squeezed in pain. Torn.RN ICU
May 26, 2020
It Hit Me
I’m Essential (noun: absolutely necessary). As an ICU Nurse, Wife, Mother & Best-Friend. The 4 most important roles in my life.ICU RN, Oakville
May 20, 2020
This year was a drive-by happy birthday for my dad.
May 19, 2020
I want to protect my patients and my family.
Do you have a COVID19 reflection to share?
You can participate by submitting the following:
- Share a short thought or reflection about your pandemic life experience (maximum 20 words).
- Submissions can capture experiences of how you feel, what you have experienced, what you struggle with, your hopes for the future, how you were uplifted by a colleague, or family of a patient, or a thoughtful comment or gesture you witnessed being done for a co-worker, etc.
We thank you for taking the time to stop by, to connect through reflections and for those who participated, for taking a moment to share in our efforts and experiences together.