CCSO will continue to function with a provincial perspective in partnership with health care providers, leaders, MOH and Ontario Health to ensure principles and elements of surge capacity management are reinforced. CCSO's tools and resources implemented in the past years will continue to support this Major Surge event.
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.
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 anticipated volumes related to COVID-19 will be of the magnitude we have yet to experience in recent memory. A response to this is requiring local, regional and province-wide inputs, drawing upon every element and principle of surge capacity management 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.
The Provincial Ventilator Stockpile Guidance document can be found here as well as the addendum document for the pandemic process here. The documentation for completion – after following the release request process identified in the addendum document – can be accessed here.
The ability to capture near real-time information on the COVID-19 status of patients admitted to Ontario critical care units will facilitate monitoring the incidence of COVID-19 in this patient population and capacity pressures and resource utilization crucial to understanding critical care activity in regions and specific hospital sites.
CCSO has developed a COVID-19 Adult and Paediatric Critical Care dashboard that is disseminated daily to our critical care stakeholders. The dashboard will provide hospitals, regions and provincial leadership with information pertinent to COVID-19 activity in critical care, and inform responsive system planning with our key stakeholders to address any emerging pressures in critical care capacity.
The timeliness and completeness of the CCIS data entry is important to ensure more accurate identification of potential system pressures and responding accordingly. Effective March 30, 2020, CCSO requests that each ICU complete their CCIS data entry (especially LSI, ventilation data, and all known COVID 19 elements) for the preceding day patients admitted before 11:59:59 , no later than 5:30 a.m. the following morning. For example, all CCIS data for Monday, March 30th, 2020 should 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.
Find out more about the Critical Care Information System here.
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:
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.
The Ministry of Health updates on how they are keeping Ontarians safe during the 2019 Novel Coronavirus outbreak. This site also includes a Public Health Ontario daily report, updated twice daily, offering provincial and regional data on confirmed cases, demographics and trends of cases since the outbreak began including geography, exposure and severity.
Ontario has taken action to ensure the province's readiness to contain and respond to the COVID-19 pandemic, including a response structure that comprises a number of tables with specific mandates.
A graphic of the Enhanced Response Structure for COVID-19 can be found here.
Public Health Ontario has developed of a wide variety of resources including best practices, fact sheets and laboratory testing information.
The Government of Canada’s website has information on the risks to Canadians, how Canada is monitoring COVID-19 and the Canadian history of COVID-19 since December 2019.
The World Health Organization outlines the global pandemic updates, travel advice, and videos from daily press briefings.
The Centres for Disease Control and Prevention provides information on how to protect yourself, family and the older population.
This platform has been created for health care professionals supporting COVID-19 and critically ill patients in the Province of Ontario. The website was developed under the auspices of the COVID-19 Critical Care Capacity Steering Committee, with the support of health care and education partners across the region.
The Ontario Ministry of Health produced a series of COVID-19 Guidance documents for a number of health sectors including acute care and long-term care among others.
The Government of Canada outlines the importance of optimizing the use of masks and respirators during the COVID-19 outbreak
This peer reviewed guideline, based on the work of a panel of international experts, provides recommendations to support clinicians managing critically ill adults with COVID-19 in the intensive care unit (ICU). Published from the European Society of Critical Care Medicine.
COVID-19 resources from the University of Toronto, Interdepartmental Division of Critical Care Medicine includes guidance and protocols, admission order sets, checklists, podcasts and webinars.
This YouTube video from the Humber River Hospital demonstrates the newly created Code Blue strategies for the COVID19 pandemic.
This document is intended to provide guidance on using anesthesia ventilators safely and effectively as ICU ventilators (PDF) (American Society of Anesthesiologists)
This document aims to provide a series of recommendations and suggestions to ensure continued high-quality clinical care in the setting of a pandemic
The PCMCH inventory includes practice support tools for providers from the various regional, provincial, federal and international organizations specific to Obstetrics and Neonatal populations.
This practice point addresses the care in the neonatal intensive care unit (NICU) for newborns born to mothers with suspected or proven COVID-19 (Canadian Paediatric Society).