Up to 70 per cent of all scheduled surgeries and procedures in the Edmonton health zone will be immediately postponed as Alberta Health Services works to free up space and front-line staff to care for patients with COVID-19.
All day surgeries will be postponed and only “priority cancer, urgent and emergent surgeries” will go ahead, AHS spokesperson Kerry Williamson told CBC News on Monday.
The change comes as Alberta’s fourth wave of COVID-19 pushes Alberta hospitals to the breaking point.
“This situation continues to be very serious,” Williamson said in a statement.
By postponing day surgeries and procedures, AHS hopes to have “sufficient ICU and inpatient capacity to manage the increased COVID activity across the zone and the province.”
Patients who are affected will be contacted and their procedures will be rescheduled as soon as possible, AHS said.
“These surgical reductions free up space for patients who require inpatient and critical care supports and allow the redeployment of frontline staff to areas of greatest need.”
‘Life and limb’
An internal AHS memo obtained by CBC News outlines the new surgical capacity guidelines. It includes details about how surge-capacity planning for the pandemic could affect triage.
The memo says the next reduction in service will be to limit surgery to “life and limb” procedures.
Based on an early warning system, the next reduction in surgical capacity could come by Sept. 17, the memo cautions.
On its website, AHS says its data-based early warning system is used to anticipate upcoming needs for inpatient and critical care beds. The system anticipates needs two weeks into the future.
On Sept. 3 — as intensive care wards began filling with COVID-19 patients — AHS postponed up to 50 per cent of scheduled surgeries and procedures in the Edmonton zone. Surgeries have also been postponed in the Calgary health zone, and across northern and central Alberta.
To date, the Edmonton zone has opened an additional 54 ICU surge beds in addition to the 72 ICU funded beds for a total of 126 critical care beds, AHS said in the statement.
As of midday Sunday, 111 of the 126 ICU beds were filled, AHS said.
“We are able to staff these beds and respond to critical care needs for the Edmonton zone as well as support the North and Central zones, who have less ability to create additional critical care capacity.
“We do not make these decisions lightly, and we acknowledge that postponing surgeries has a significant impact on patients, their families, and their loved ones.”
‘The pressure is severe’
The pressure on hospitals has led to concerns from doctors and frontline health-care workers who fear that resources may become so overwhelmed they may be forced to choose which COVID-19 patients receive life-saving care.
AHS is not enacting emergency triage protocols but critical care teams have been asked to “re-familiarize themselves” with the protocol, Williamson said.
The triage protocol would only be activated when all available resources for critical care and “all other mitigations” have been exhausted, he said.
“The pressure on our ICUs is severe, and AHS is doing all it can to increase capacity so that all patients needing critical care will receive it,” Williamson said.
The cancellations — and the uncertainty around what might come next — are frustrating for doctors and devastating for patients, said Dr. Shahzeer Karmali, a general surgeon at Edmonton’s Royal Alexandra Hospital.
As more operating rooms close, patients awaiting surgery will begin clogging up emergency rooms, Karmali said.
For his cancer patients, prolonged delays mean a diagnosis could change from curable to incurable.
Karmali said he’s already had to inform many of his patients of cancelled surgeries and the news is most often met with tears.
“It’s devastating. It’s devastating for them to hear it,” he said.
“I don’t even want to think about, how are we ever going to catch up?… Disease doesn’t stop because of the pandemic.”
With few public health restrictions in place, Karmali said he fears the pressure will only become more crippling and doctors will need to triage critical care.
If the “life and limb” protocols are enacted — restricting surgeries to those injuries or conditions that need surgery within 12 hours or less — preventable deaths will take place in Alberta hospital wards, he said.
“There’ll be significant morbidity,” he said. “We need some sort of plan. How are we going to temper this current wave?
“What if we haven’t? What if the peak is still coming in another two weeks. Can this system hold tide for that time period? I’m worried that it can’t or won’t.”
Alberta continues to lead the country in daily new COVID-19 cases and active cases.
On Friday the province reported 1,473 new cases. There were 16,265 active cases across Alberta.
Alberta reported 10 more deaths from COVID-19 on Friday. There were 686 people being treated in hospital, 169 of whom were in intensive care beds.
Of the 517 non-ICU, 74.1 per cent are unvaccinated or partially vaccinated. Of the 169 in ICU, 91.2 per cent are unvaccinated or partially vaccinated.
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