A Vancouver community hospital no longer provides long-term mechanical ventilation for patients who require this service, including those suffering respiratory failure as a component of a chronic critical illness.

That's because the four-bed intensive care unit at Mount Saint Joseph Hospital was quietly replaced in April with a six-bed "high acuity unit". 

The site leader and program director for medicine and ambulatory, Sandra Barr, told the Straight by phone that Mount Saint Joseph still has the ability to support people suffering from cardiac arrest on a 24/7 basis.

The emergency room at the hospital at 3080 Prince Edward Street remains open from 8 a.m. to 8 p.m.

"In cases when a patient does require a ventilator, we very quickly and efficiently transport them to St. Paul's—to the intensive care unit there," she said. "HIstorically we have always transferred critically ill patients that require a higher level of care to St. Paul's or VGH."

When asked what this means for patients with pneumonia, which sometimes requires ventilation, Barr replied: "We have the ability to manage patients with noninvasive ventilation."

She added that this can take place for those requiring high-flow oxygen, including those with pneumonia or a significant infection, in the high acuity unit where there's a higher level of monitoring.

"If they deteriorate to the point that they need to be intubated and ventilated, we can do that here and transfer them to St. Paul's," Barr said. "Most pneumonia patients don't deteriorate like that, especially if we intervene early enough and treat them with IV antibiotics and monitor them closely."

In addition, spirometry and bronchoscopy testing is still available at Mount Saint Joseph to diagnose lung conditions.

If necessary, Barr said the hospital also has an on-call surgical team that can do an emergency tracheostomy.

"What's happened over time is ambulances have taken the very sick patients to the higher-level emergency [rooms]," she stated. "So they'll rush past us to go to VGH with a trauma or a head injury or a stroke or a heart attack."

Mount Saint Joseph comes under the umbrella of Providence Health Care, a nonprofit organization that also operates St. Paul's Hospital and several other facilities in partnership with provincially funded health authorities.

In September 2015 Vancouver General Hospital also opened a high-acuity unit, which could accommodate up to 12 patients.

According to an article on the Vancouver Coastal Health website, the HAU "cares for patients requiring increased monitoring and resuscitation in a multidisciplinary environment".

“The HAU isn’t meant to serve as a step-down unit for Intensive Care Unit (ICU) patients,” patient services manager Jackson Lam said in that article. “In fact, we work closely with the Critical Care Outreach Team to catch ward patients who are not doing well and save them from the intensive and intrusive procedures in the ICU.”

Barr said that at Mount Saint Joseph, the critical care nurses would sometimes have to go to St. Paul's where they were desperately need for shifts because there wasn't enough of this work to do at the East Vancouver community hospital.

By creating a high acuity unit, she pointed out that critical care nurses could be moved to St. Paul's Hospital and high acuity nurses have been deployed at Mount Saint Joseph.

"Historically, our ICU was filled with high acuity patients, so we had a bit of a mismatch in terms of the skill required," she said.