Ontario tells hospitals to stop non-emergency surgery, procedures to maintain critical care capacity

The Government of Ontario has instructed hospitals and healthcare professionals to stop all non-emergency surgery and procedures to maintain critical care capacity and human resources.

The directive went into effect Wednesday.

Alexandra Hilkene, spokeswoman for the Ontario Department of Public Health, said in an email Wednesday that the province has reinstated what it calls “Guideline # 2” in response to the growing proliferation of the COVID-19 Omicron variant.

“While this was not an easy decision, this time-limited measure will help maintain and increase hospital bed capacity by making between 1,200 to 1,500 acute / post-acute beds available as needed,” Hilkene said.

“This decision will be closely monitored on an ongoing basis with the intention of bringing surgical capacity to safety as soon as possible.”

Response to Omicron spread

The directive, signed by Dr. Kieran Moore, Ontario’s Chief Medical Officer of Health, says action is needed because of the proliferation of the highly transmissible Omicron variant.

“Specifically, cases are at the highest level since the onset of the pandemic (> 18,000 per day) and a continuous acceleration in cases, and increased hospitalizations are expected in January 2022,” he says in the guideline.

“New data show that two doses of a COVID-19 vaccine provide little protection against severe Omicron infection, and three doses are needed for better protection … for all patients.”

Emergency operations must continue

In the guideline – issued to “regulated health professionals as persons operating a group practice of regulated health professionals” – Moore states that the following steps are immediately mandatory:

  • “All non-emergent or non-emergency surgery and procedures must be discontinued. Emergency and urgent surgery must be continued, in an effort to reduce and prevent patients morbidity and mortality.
  • All non-emergent or non-emergency diagnostic imaging and outpatient clinical activity should be discontinued unless it is directly related to the provision of emerging or emergency surgery and procedures or to pain management services.

Moore says health professionals are “in the best position” to determine what is urgent or an emergency in terms of surgery, procedures, diagnostic imaging and outpatient clinical activity in their specific fields.

When making decisions about what to stop or postpone, health care professionals should be guided by their regulatory colleges and such principles as proportionality, minimizing harm to patients, equality and reciprocity, he says.

“As this epidemic evolves, there will be continuous assessment of emerging evidence to understand the most appropriate measures to take to protect healthcare providers and patients,” says Moore.

“This will continue to be done in collaboration with Public Health Ontario health system partners and technical experts and with the health system.”

The directive comes as the number of people in the hospital with the virus in Ontario reached 2,081 – 288 of them in intensive care units being treated for COVID-19 related diseases. The province also reported at least 11,582 new cases.

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