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.
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
Simulation Based Education for Alternate Models of Care
Ontario hospital teams are invited to participate in a virtual simulation program designed to help you communicate effectively within a team-based model.
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
Staffing strategies and alternate models of care
Credit: Sunnybrook Health Sciences Centre
Health Human Resources: Expanded Team Based Models of Care
These resources are to provide guidance for organizations about activating Team Based Models of Care in response to the growing COVID 19 pressures
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
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
Mental Health Support for Health Care Workers
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.
COVID-19 Guidance Documents
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.
Optimizing the Use of Masks and Respirators
The Government of Canada outlines the importance of optimizing the use of masks and respirators during the COVID-19 outbreak
Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with COVID-19
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.
Critical Care Resources from University of Toronto
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.
Humber River Hospital Protected Code Blue Strategy Pandemics
This YouTube video from the Humber River Hospital demonstrates the newly created Code Blue strategies for the COVID19 pandemic.
APSF/ASA Guidance on Purposing Anesthesia Machines as ICU Ventilators
This document is intended to provide guidance on using anesthesia ventilators safely and effectively as ICU ventilators (PDF) (American Society of Anesthesiologists)
COVID-19 Practice Support Tools for Obstetrics and Neonatal Providers
The PCMCH inventory includes practice support tools for providers from the various regional, provincial, federal and international organizations specific to Obstetrics and Neonatal populations.