As Toronto’s Hospital for Sick Children begins the early stages of its massive redevelopment and expansion, officials have recreated an intensive care unit patient room to highlight the crowded physical challenges facing medical staff.
“What people outside of SickKids might not realize is that it’s not all about the pretty atrium people see and we have phenomenal outcomes and are able to deliver care in an environment that is already significantly outdated,” Dr. Michael-Alice Moga, a staff cardiac intensivist in the hospital’s critical care medicine department, told Global News.
“We’re used to being the ones that people come to for help … so right now we’re faced with the situation that sometimes we’re not all that comfortable with, where we’re opening up our problems and our struggles to other people and asking other people for help because this is beyond what we can do as health-care providers.”
In a tenth floor corner of the downtown hospital originally built in 1949, a partnership between SickKids and Airbnb saw a conference room converted into a four-bed room — complete with sounds, and equipment used on a daily basis — meant to show what it’s like to give care within its ICU.
The hospital’s three-hour experience was listed for a total of $16,744 (representing the cost of operating such a room overnight) or $2,392 a person, and all funds raised are going toward its $1.3-billion campaign called SickKids VS Limits. The campaign is scheduled to run until 2022.
By 2030, a new patient care centre on University Avenue and a patient support centre on Elizabeth Street are set to be completed along with renovations to the atrium portion of the facility. Money raised will also go toward pediatric health research and patient care initiatives.
Moga said the age of the current facility combined with the design standards at the time aren’t compatible in a present-day medical world — especially given the amount of advanced technology now used in treating children ranging between premature infants, weighing a couple of kilograms, to fully-developed 17-year-olds.
When it comes to treating ill children, she said the use of technology is critical because children aren’t always able to articulate what is wrong with them.
“As we’ve gotten better and better at caring for these children, we’ve created a sub-population of kids that are technology dependent at home and then come to the hospital more often. Our patients are sicker in general in hospital than they were 10 years ago,” she said.
She said there are “significant challenges” on a number of fronts facing staff in the hospital. Among the first to come to mind for Moga was confidentiality.
“There is not a day that I’m actually caring for patients that I don’t wish my environment was different. It impairs my ability to talk to parents with privacy,” she said.
“Right now in multi-bed rooms, we either have to ask other families to step out as we talk about a particular child for privacy reasons or we have to have them wear noise-cancelling headphones.”
During a tour of the room, Moga pointed out areas affecting infection control processes. She noted before moving from bed to bed in the same room, staff need to wash their hands if stepping outside boundaries surrounding each patient. Moga said accessing hand washing stations can be difficult because of different pieces of medical equipment.
“We’re not able to keep things as clean as we necessarily need to have them and figuring out where to put all the equipment in the room so that people can actually get to it in an appropriate manner is a daily struggle,” she said.
“On top of that, a child that has a cardiac arrest or an acute event, we’ve seen over and over in real-time and high-fidelity simulations that the environment impairs the ability of the team to act in those instances.”
Moga went on to discuss how the present multi-patient rooms can have “significant psychological impact” on children and families.
“It’s not difficult for I think any of us to think about times we’ve been doing something in another bed spot or a procedure or a resuscitation. I can distinctly remember in my head looking over my shoulder and seeing a three-year-old in the bed space next to me looking at us doing these things,” she recalled.
“Those children have had nightmares and symptoms of PTSD as have families, and that’s something we can pull a curtain but they can still hear. There’s only a certain amount of things that we can do to provide that psychological safety for those patients and make sure they don’t suffer from the stressers of not just what they’re going through but this shared experience that they’re going through.”
Moga said current best practices call for all patients to have natural light, higher room ceilings, more physical space for patients and staff for comfort, work and infection control purposes, and reducing the amount of noise patients are exposed to.
“We often times say that we take away the basic rights of the people that we treat, unfortunately,” she said.
“The environment means they can’t go when they want to, they can’t eat or drink when they want to, they certainly can’t sleep at their child’s bedside when they want to, so unfortunately the environment adds to stress rather than taking away stress for these families that are really in a nightmare situation.”
When asked about the planned new facilities at the Hospital for Sick Children, Moga said she is optimistic about what the future holds for patients, their families and staff.
“My biggest hope the environment can now match the care we’re giving. We’re delivering care that is beyond that of anything else in the world,” she said.
“In bringing that environment up to speed, we then can provide a more comprehensive experience for our families and our patients — and a more holistic approach to things too.
“Right now we’re forced to deal a lot with the technology and the medicine, but we want to be able to step back and remember this is a child. This is a child that is part of a family and our whole goal is to return that child to that family with as minimal impact to the rest of their life as possible.”