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Restrictions on elective hospital admissions may be insufficient to meet demand in pandemic


Restrictions on elective hospital admissions instituted during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak in Toronto may be insufficient to deal with the increased numbers of patients needing hospitalization during even a mild flu pandemic in the city, a new study from the Institute for Clinical Evaluative Sciences (ICES) shows.

“Many jurisdictions are developing plans to manage the large number of influenza-related hospital admissions that are expected to occur during a possible flu pandemic,” said Dr. Michael Schull, ICES scientist and lead author of the study.

“One proposed strategy to provide hospitals with the capacity to accommodate these patients is to restrict elective hospitalizations; however, the degree to which this measure would meet the anticipated need is unknown.”

In order to help quantify this issue and to assist healthcare planners, ICES scientists looked at the Ontario Ministry of Health and Long-Term Care’s estimates of influenza-related hospitalizations in the first eight weeks of a mild, moderate, or severe pandemic in Toronto. They compared those with the actual reduction in the number of hospital admissions in the first eight weeks of the widespread restrictions instituted on non-urgent hospital admissions during the SARS outbreak in Toronto.

It is estimated that there will be 4,819 influenza-related admissions in the first eight weeks of a mild pandemic, but that this would rise to 8,032 or 11,245 in the first eight weeks of a moderate or severe pandemic, respectively. In the first eight weeks of SARS-related hospital admission restrictions in Toronto, hospitalizations were reduced by 3,654. Therefore, influenza-related admissions could exceed the reduction in admissions resulting from restricted hospital utilization by 1,165 to 7,591 patient admissions, or 4 to 25% of current capacity, over the first eight weeks of a pandemic, depending on its severity.

These estimates do not account for the reduced hospital capacity that could result from influenza cases among hospital staff and, as such, the excess of influenza admissions could be even greater.

“Our analysis shows that in the event of even a mild pandemic, additional measures beyond hospital admission restrictions will likely be required to provide the necessary hospital capacity in Toronto,” said Dr. Schull.

“These measures could involve more rigorous implementation of hospital restrictions to further reduce elective admissions, such as developing uniform guidelines to determine which patients can be safely deferred for elective surgeries.”

The study, “Surge capacity associated with restrictions on nonurgent hospital utilization and expected admissions during an influenza pandemic: lessons from the Toronto severe acute respiratory syndrome outbreak”, is in the November 2006 issue of the journal Academic Emergency Medicine.

Author affiliations: ICES (all authors); Clinical Epidemiology Unit (Drs. Schull and Stukel), and Department of Emergency Services (Dr. Schull), Sunnybrook Health Sciences Centre; Departments of Medicine (Dr. Schull), and Health Policy, Management and Evaluation (Drs. Schull, Stukel, Guttmann, and Zwarenstein), University of Toronto; Division of Pediatric Medicine, The Hospital for Sick Children (Dr. Guttmann).

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.


  • Julie Dowdie
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