OPINION: The need for changes to critical care in the post-COVID era

The onset of the COVID-19 pandemic brought passionate pleas for life-saving ventilators and horror stories of hospital’s running out of space in their intensive care units (ICUs) from around the world.

ICUs, where the sickest of the sick are cared for, were a major concern for every politician and health administrator. But what will the lasting effect of COVID-19 be on ICUs and critical care?

As for likely all areas of society, there will be changes in critical care in the post-COVID era. As happened after the SARS epidemic of 2003, there will be renewed investment into critical care with grandiose promises but, as is often the case, as the spotlight fades so will this commitment.

However, the importance of it will not diminish and if anything it will grow. Projections for critical care demand are that it will surge as our population ages and patients are living longer and with the advent of innovative, complex life sustaining procedures.

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Challenging this growth is the reality that with Canada spending 11.5% of its GDP already on healthcare, including 1% of GDP going to ICU care, further increases are unrealistic. Thus, we will need to deliver more ICU care by spending less. Such a paradox is solvable using innovation and accepting changes- some painful and difficult.

Existing ICUs are designed to provide all levels of advanced care in a labour intensive, technological and expensive fashion. They are excellent at what they do but are not exactly nimble or proficient.

Building bigger and more complex ICUs will not be the answer. Rather the solutions require critical care to be more portable, more local, more agile and more efficient. We do not need to bring every patient to an ICU, but rather let’s bring the ICU to the patient.

Presently ICUs employ some of the most advanced technology in hospitals including monitors and medical devices. Many of these are portable and can be observed remotely (including mobile devices). By having the information sent to a central location, one healthcare worker can care for more patients effectively increasing the provider-patients ratio.

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Clearly this approach requires a rapid effective response when a need arises, but the economy of this is undeniable. Artificial Intelligence will undeniably increase the ratios further and add safety by identifying concerning trends sooner and by helping to filter out the vast amount of misinformation or ‘noise’ the devices send to observers.

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This remote ability however allows care to be provided beyond the traditional ICU boundaries and critical care can be extended throughout a hospital and even further to other facilities across Canada. All that is required is having highly qualified health professionals who can respond where the patient is.

However, for lower levels of care, different professionals can provide those services. Be it the healthcare aide cleaning a patient instead of a nurse or a pharmacist adjusting a medication instead of a physician, as long as we all work together as a team, a more efficient care model is possible.

Hospitals and health professionals will need to change how they deliver critical care into a more efficient manner. However, the public will also have to understand that changes are necessary.

Presently, more than 10% of all healthcare expenditures are spent on patients in their last 30 days of life. Everyone deserves care and chances to recover but unlimited, unending care is not sustainable. Realistic expectations and only providing care when there is reasonable hope of a meaningful outcome will also need to come to allow us to increase the delivery of critical care.

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The COVID-19 pandemic may seem relentless but it will end having caused lasting effects and unforeseen changes. It is undeniable that critical care will be forever changed.

If health professionals, governments and Canadians are willing to learn from COVID, if they are willing to adapt and do things differently, together we can make things better and allow Canada to provide better care for more.

Dave Neilipovitz is a Critical Care Department Head in Ottawa and a regional lead for Critical Care in Ontario.
Kwadwo Kyeremanteng is an Intensive Care & Palliative Care physician at The Ottawa & Montfort Hospital. 

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