As we developed the Phase 2 Consolidation Plan, we knew that there would be an increase in patient flow to Cardiac Sciences- primarily at SBH, but also in conjunction with expanded CSP services at the GGH and HSC. That increase in activity was proposed to be accommodated by the increase in CTU beds (from 32 to 48) an increase in ACCU beds (from 8 to 10) and increased CA/PA support for the CTUs as well as for enhanced consultation services at GGH and at HSC. Additionally we proposed to continue the recruitment of general cardiologists (as originally supported in the Peachey Report) and expand lab services (e.g., in expansion of the EP lab services to a 5 day a week schedule). Although some of these components have been implemented, i.e., expansion of the CTU bed map and recruitment of CAs/PAs, many of the required components of the Plan are still awaiting approval/implementation.
Notwithstanding that some of these plans are still awaiting approval, the anticipated patient shifts we expected to be triggered by consolidation have already occurred. These shifts are readily apparent in many of your lived experiences- especially those attending on the CTUs and ACCU over the past several months. As depicted in the appended chart (thanks to Chris Kuzminski for compiling), over the past 6 months, Cardiology/Cardiac Surgery consults from the ED have doubled. Cardiology admissions have increased by more than 30%. These rapid increases, in advance of the opportunity to establish a stable CTU structure or to integrate the new CA/PAs into the program have stretched us to the limit. Our CSP critical care services are especially stretched, further aggravated by the contraction of our critical care bed base with the closure of the HSC CCU beds and the inability to expand to the pre-approved 10 beds in the ACCU. The consequence is that ACCU and Cath Lab attendings, on a daily basis are scrambling to find beds for STEMI and post-arrest patients.
There are ongoing discussions with the SBH, WRHA and Shared Health to fix this. We have pressed for re-opening an expanded CCU at HSC (back to 6 beds) as a short term outlet for our SBH critical care units and have proposed to the site and region the establishment of an Intermediate Cardiac Care Unit (ICCU) at SBH for management of intermediate risk CV surgery and Cardiology patients (e.g., low risk STEMIs, TAVI patients). Further, we have 5 new CA/PAs that are gearing up to bolster support. However, in the short term, we are in a “all hands on ship” situation.
On behalf of the CSP I can share our daily appreciation of all of you who are keeping the ship afloat in very difficult times.
Congrats to Shelley Zieroth who was was appointed as an honorary fellow of the Heart Failure Society of America.