‘The situation was so devastating’: How Sick Kids transformed to treat gravely ill adults with COVID 

‘The situation was so devastating’: How Sick Kids transformed to treat gravely ill adults with COVID 
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Lee-Anne Williams, charge nurse in the pediatric intensive care unit, checks vitals of an adult COVID patient in Sick Kids’ ICU.

By Megan Ogilvie Health Reporter

Sun., June 20, 2021timer7 min. read

They were grateful the virus largely spared children, and that detailed plans to manage a surge of critically ill kids weren’t needed. But staff felt helpless as COVID patients threatened to overwhelm neighbouring hospitals.

Then, at the beginning of April, after provincial modelling predicted there could be 800 COVID patients in ICUs and physicians worried about the grim possibility of rationing care, Sick Kids enacted its pandemic plan of last resort.

For the first time in its history, as part of a provincial response.

“There was a desperate desire to be helpful,” said Jackie Hubbert, clinical director of the hospital’s pediatric intensive care unit.

Sick Kids accepted its first two adult COVID patients on April 8. Days later, the new eight-bed unit was filled, and staff were seeing firsthand how the virus attacked bodies and ravaged lungs.

“I don’t think we understood until we saw them — had them in our building — how sick the patients can be,” said Jason Macartney, Sick Kids’ clinical manager of respiratory therapy.

At first, the hospital hadn’t planned to take COVID patients, instead proposing to admit others who were critically ill, perhaps trauma patients or adults being treated for severe complications from diabetes, to help relieve some pressure in the health system.

“It became clear that wouldn’t be helpful; there wasn’t enough of those types of patients,” said Dr. Elaine Gilfoyle, division head of the pediatric intensive care unit. “The only way to help was to take COVID patients.”

Once the decision was made, staff had just over one week to get the new unit ready.

Though confident they could care for critically ill adult patients — the hospital sometimes has adult-size teenagers in their ICU, and occasionally provides care for young adults in their early 20s with complex medical needs — the checklist of tasks to complete on short notice was daunting.

The electronic medical records software geared to children had to be updated for adults. Medications had to be ordered, and IV pumps individually reprogrammed; in pediatrics, medications are prescribed by a patient’s body weight, while adults typically receive a standardized dose.

Dietitians had to come up with new feeding regimes, while physiotherapists had to practise protocols for larger adults. And staff in the ICU had to ensure all the medical equipment and supplies were suitable for the incoming patients, imagining what they might need for, say, a 200-pound man.

“We even had to work out how to take these bigger patients for diagnostic testing,” said Hubbert. “There was a ton of work and so many moving parts. I’m pretty sure our pharmacy staff and IT staff didn’t sleep one whole weekend to get all the order sets and information into our systems.”

While ICU staff had cared for pediatric patients with COVID, the disease attacks adults in a different way. Gilfoyle prepared learning materials for her staff and invited critical care leaders from Brampton Civic Hospital to share their experiences caring for COVID patients in a provincial hot spot.

Techniques for proning patients — positioning them on their stomach — to help better distribute oxygen in their lungs during acute respiratory distress was among the biggest concerns for Sick Kids ICU staff, Gilfoyle said. It can take up to eight people to safely flip a patient hooked up to a ventilator and other life-saving interventions.

“That was one of the things that caused a lot of anxiety in advance,” she said. “We sometimes prone children, but their chests are smaller and stretchier, and it doesn’t help as much; it’s not something we did consistently with children.”

Lee-Anne Williams, charge nurse for the pediatric intensive care unit, was on shift the day the hospital was ready to accept its first adult COVID patient. She recalls being surprised by the number of other hospital physicians calling in, asking for help.

“It really brought to my attention how burdened our ICUs were in that moment; it was very eye-opening,” she said. “We’d been following the numbers and case counts in the province and checking in with others in the medical community, but that day it all became more personal.”

Williams spoke to the paramedics from Ornge, the province’s air ambulance and critical care transport system, who brought in the first COVID patient and were surprised they had been directed to Sick Kids with an adult on their stretcher.



“This man, who was very clearly a seasoned paramedic, looked defeated. I asked him if he was OK and he said ‘No.’ I just remember thinking how exhausted he looked.”

In the first 10 days of April, 130 COVID patients were transferred out of overloaded hospitals to others across the GTA and beyond — some as far away as London and Kingston — with paramedics working flat-out to accommodate all the transports.

In the ICU, staff used a large white board to keep track of any concerns and to list items still needed to care for their new patients, including larger bed linens, extra pillows and razors and shaving cream.

“Some of our patients were men and our little tiny razors we sometimes used on kids before surgery weren’t up to the task,” said Hubbert, adding staff shave and clean areas on patients’ bodies ahead of a medical procedure. “If they’re intubated, we might also have to shave their faces to help keep the tubes taped down. We weren’t used to having big hairy men in our ICU.”

By the end of April, with close to 900 COVID patients in ICUs, Ontario’s five pediatric hospitals were caring for — or preparing to admit — adult patients with the virus. Also that month, Sick Kids started to accept pediatric patients from GTA hospitals to create more space for COVID patients in the system. Between April 12 and May 26, the hospital cared for 372 pediatric patients “who normally would have been cared for in their local hospitals,” a spokesperson said.

As the weeks passed, ICU staff got into a rhythm caring for the new patient population. While treatments and techniques largely became routine, staff didn’t expect the emotional toll of caring for critically ill adults.

“Normally, we’re talking to parents and having them make decisions about their children,” said Macartney. “Now we’ve got patients in the unit that are able to make their own decisions, and we’re talking to husbands and wives and, in some cases, children to help make some of the decisions around their care.”

For staff, it was different being at the bedside of patients who had recently been married, or who had young children at home, often the same age as themselves.

“The patients were so relatable; the disease became very real and frightening — like it can strike anybody, anytime,” said Williams, who has been a nurse in the pediatric ICU for more than 20 years.

Though she has helped families cope at the bedside of a very sick child, and been witness to tough days in the pediatric ICU, Williams says these past months have been hard in unexpected ways. Among the memories she won’t forget are the fear on a patient’s face before being intubated, seeing a gravely ill patient’s children playing at home during a Zoom call, posting family photos on the walls of a room so staff can get to know the sedated patient lying ill on the bed.

“With children, there is always a family member at the bedside. With these adult patients, their family was often at home,” Williams said, adding a child-life specialist tried to lessen the fear for young kids whose parent was sick with COVID. “She wanted them to know what to expect if they saw their mother or father sick on a ventilator.”

As of June 18, Sick Kids has cared for 36 critically ill adults with COVID-19, the youngest in their early 20s and the oldest in their mid-50s, with some treated with extracorporeal membrane oxygenation machines, or ECMO. Expertise with the sophisticated life support machine for pediatric patients is one of the reasons why the hospital could help during the third wave.

Williams wishes she could get to know the many COVID patients she treated, saying the past months — while hard — will be a highlight of her nursing career. She knows her colleagues in nearby hospitals worked harder, for longer, and says she is in awe of their stamina.  

For her, the happy moments will outweigh the sad ones: Seeing a patient smile after a long stretch on a ventilator, or celebrating when patients are well enough to be transferred across the street to Mount Sinai Hospital to finish their hospital stay.  

“Clapping them out, all of us happy they made it, that’s something I will remember.”
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