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.
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 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.
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 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 (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.
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.
If you are a health care worker impacted by stress related to COVID-19, support is available to help you cope. This support includes resources you can access on your own, with a group of peers or with a clinician.
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).
Three major areas of focus have been identified as leading practices or innovations to be implemented for organizations during the pandemic to support staff.
To provide staff with resources to improve mental well-being
To provide senior leaders with resources to provide safe, efficient and transparent team based strategies during the pandemic
To provide staff with the opportunity for additional education for redeployment and/or upskilling
Confirmation of PPE Supplies
Credit: Waterloo Wellington LHIN
Implementation of a PPE Coach Role
Credit: The Hospital for Sick Children
Assistance for staff dealing with a stressful situation
Credit: Unity Health Toronto
Checklists to practice gratitude before and at the end of a shift
Credit: Hamilton Health Sciences
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
Module to support upskilling and education
Credit: Unity Health Toronto
Course to review skills and have a preparedness plan for COVID
Credit: Health Sciences North
A dedicated critical care educator to provide an in-house critical care course.
Credit: Southlake Regional Hospital
The Michener Institute module to support upskilling and education.
Credit: The Michener Institute of Education at UHN
Small and rural hospitals COVID management response
Credit: Thunder Bay Regional Health