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Ethical choices over who receives critical care are already occurring in SK: SHA

Ethical choices about who receives appropriate level of critical care and who receives substandard care are already occurring in Saskatchewan hospitals. This, according to information presented to doctors on Thursday night and shared on social media. The presentation is a regularly occurring virtual town hall for Saskatchewan doctors presented by the Saskatchewan Health Authority.

Overall the slides from the event present a bleak picture of the current situation in the province's ICUs. Some notable assessments - patient to staff ratios are already eroding, affecting quality of care, and according to the presentation, this leads to an increasing risk of potential patient harm and preventable death.

At present ICUs are operating in the red zone on the health authority's four level system. The red zone is the second highest level that includes green, yellow, red and black. Level red is activated when:

  • ICUs see 117-149 patients

  • 10-20% overtime usage

  • Baseline ICU registered nurse:patient ratio significantly altered

  • Triage widely applied

  • Widespread service slowdown and required use of non-ICU staff

  • Out of province transport of ICU patients

As of Wednesday morning, October 21, Saskatchewan had 117 patients in ICU and 57 patients on high flow oxygen not in ICU. Impacts of managing in the red zone include evacuation of ICU patients out of province and increased preventable deaths.

Here are some other findings from the presentation:

  • Trendline for number of patients in ICU show in excess of 140 people will need ICU care by end of October

  • Saskatchewan has the highest per capital number of people in ICU in the country

  • SK leads the country in deaths over the last 14 days, with 5.7 per 100,000

  • SK has the highest new case rate among the provinces per 100,000 over the last 7 days

  • Test positivity rate is high and is not declining

The presentation includes recommendations - small gathering limits, capacity limits,

schools open using hybrid teaching, cohorting, ventilation, masking, isolation of cases, and frequent testing.

In response to the COVID-19 pandemic, the SHA hosts a provincial Physician Town Hall every two weeks with information tailored for doctors. The presentation and recording are usually made available to everyone on the SHA's website after the event.




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