Pediatric ward closure in Kelowna triggers fears of ripple effect in B.C. hospitals

Dr. Jeff Eppler, an emergency room physician at Kelowna General Hospital, is getting ready for a hectic summer.He’s not only thinking about the typical seasonal spike—but the ripple effects of the closure of the hospital’s dedicated pediatric ward from May 26 to July 4 due to what Interior Health called “limited physician availability.”“It’s very difficult, but then you throw this pediatric service disruption in . . . (it’s) just going make our life a lot more difficult, especially as we go into the summer, as things become much busier,” he said. Dr. Eppler said ER staff would have to treat some children who would typically be directed onward to pediatrics.“We can provide safe and effective acute care, but rely on our pediatric colleagues for their support and far deeper knowledge, as well as for providing ongoing care. We cannot be de facto pediatricians as a long-term solution to this current crisis,” he said.And Dr. Eppler predicted the resource drain would extend outside the hospital, to ambulance services, as Kelowna General is forced to send other children to other hospitals, in Vernon, Penticton, or potentially even the Kootenays more than 300 kilometres away.Typically, it’s the other way around.“So it’s kind of reverse of what we normally do,” Dr. Eppler said. “That certainly ties up ambulances, resources, and it’s not great for families or kids, who have a one-to-four hour drive to the other centre.”The closure of Kelowna’s pediatric ward is part of ongoing hospital staffing shortages that have caused rolling closures of emergency rooms across the province. Service disruptions at the pediatric ward and concerns about the state of care at Kelowna General are also not new. But the abrupt nature of the pediatric closure last week, and a recent warning from doctors about maternity care is putting one of the province’s biggest regional hospitals in the spotlight. Nine doctors working in the department of obstetrics and gynecology released a statement last month warning about a “growing crisis” in maternity care putting the “safety of patients and newborns” at “serious risk” unless officials take immediate actions.They said primary maternity care at the hospital was “facing a collapse” as early as June 1 because of a “critical shortage” of family physicians willing or able to provide such care.“This means that many pregnant patients may arrive at the hospital in labour with no doctor available to provide safe, continuous care during delivery.”Then came the closure of the pediatric ward last week. It should have 12 full-time pediatricians, Interior Health said, but when it closed, staffing was put at five and a half doctors.Susan Brown, president and chief executive officer of Interior Health, said the ward was closed to “preserve the higher level of care” offered by the pediatricians, who will be redeployed. “So that would be on our neonatal intensive care unit and some other work at the site,” she said. “So we’ve done that to ensure safe patient care, but also thinking about the wellness and retention of the medical staff who continue to go above and beyond.” The hospital with 497 beds received 95,022 emergency room visits in 2023-24, according to Interior Health.It not only serves Greater Kelowna with an estimated population of 235,000, but is also one of two “tertiary referral hospitals” providing specialized and complex care to a larger region that is home to almost 900,000 people.Adriane Gear, president of the BC Nurses’ Union, said nurses at Kelowna General are now responsible for managing acutely ill pediatric patients in an “already strained emergency department setting” not designed for ongoing pediatric in-patient care.“This compromises safety, delays treatment, and can increase the risk of poor outcomes,” she said in a letter shared by the union.“Nurses entered this profession to deliver safe, high quality care—not to be forced into situations that put their patients at risk.”Dr. Eppler meanwhile predicted the pediatric ward closure would worsen ER wait times.“We definitely provide good quality care, but it’s becoming increasingly challenging, even before this disruption in pediatric services,” he said. “We have been coping really for years, and we have been sounding the alarm for a long time, like a broken record.”Dr. Eppler said overcrowding “is really contributing to moral injury and burnout” among physicians and nursing staff. A report from the Montreal Economic Institute released this month said that the median length of a stay in Kelowna General’s emergency room was three hours and 24 minutes, lower than the provincial figure of four hours, 13 minutes.Dr. Eppler said about 10% of ER admissions involve children. “On some days, none of those pediatric patients, once they’re seen, will need to go in the hospital,” he says. “But some days, we might admit three or four of them.”Dr. Eppler said Wednesday that seven transfers of pediatric patients from Kelowna General to other hospitals had taken place since the ward closure, a figure confirmed by Interior Health. “But I know those numbers are gonna go up there,” he said. “So you are gonna see sick children that are going to need admission, and we are going have to transport these patients, if there are beds available at other centres.”Mayor Everett Baker of Grand Forks, a community of some 4,100 about 200 kilometres southeast of Kelowna, said he was concerned about the situation at Kelowna General. Grand Forks has a community hospital with nine ER beds, but depends on other hospitals for more specialized services. Kootenay Boundary Regional Hospital is Grand Forks’ primary hospital for pediatric care, but Kelowna General had served as a secondary destination, he said. While the closure of the pediatric ward at Kelowna had not yet had an impact on Grand Forks, he agreed with Dr. Eppler’s prediction of ripple effects throughout the region.“If there’s something that goes on in Kelowna, it can’t help but affect other regions just because it is such a major hospital,” Baker said. Small rural communities have fewer options than urban areas, he said. “It’s a different dynamic because in Vancouver, you might have four or five different hospitals … you can access.” Brown said Interior Health was also concerned about the effects of the pediatric closure on other hospitals.She said the ER department would remain open to any pediatric patients. “But should your child need to be transferred to an alternate site, we have added resources to ensure that there’s time to do that in a safe way,” she said. Brown said an additional pediatrician would arrive in July with two more in September. But she could not commit to reopening the ward on July 5, saying the date would be set in consultation with doctors.B.C. Health Minister Josie Osborne said Friday that she had talked with Brown about recruitment at Kelowna General. She said her ministry was working with doctors to ensure services are in place during a “very, very challenging time.”Osborne added that recruitment issues at the hospital should be seen within the “context of a global health care worker shortage.”

Pediatric ward closure in Kelowna triggers fears of ripple effect in B.C. hospitals

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