By Catherine Danko
A ski accident left Robert Webster paralyzed and unable to breathe on his own.
After being discharged from the Intensive Care Unit (ICU) once medically stable, Robert was transferred to the Transitional Home Ventilation service at UHN's West Park Healthcare Centre, which helps patients who are chronically ventilated in an ICU safely transition back home or within their communities.
Now, thanks to funding from the Ministry of Health, the outstanding care that Robert received at West Park is being expanded to hospitals across the province of Ontario.
Initially piloted under the expertise of clinical staff at West Park in 2021, the Provincial Long-Term Ventilation Strategy (PLTVS) will enhance quality of life for ventilator-dependent patients such as Robert, showing promising potential to improve patient flow out of critical ICU beds, ensuring that resources are in place for those with urgent needs.
"West Park's program allowed me to adjust to an assisted ventilation system that I could eventually use back home," says Robert, a quadriplegic since the accident in 2008. He has been successfully living in his Toronto community for more than a decade.
In collaboration with Critical Care Services Ontario, the PLTVS has developed a provincial hub-and-spoke model with four hub hospitals — UHN's West Park and Michael Garron Hospital (Central), The Ottawa Hospital (East) and London Health Sciences (West) — and over 100 spoke providers delivering LTV care across the province. Read more about the strategy.
The aim of the hub-and-spoke model is to create a structure that allows every hospital across the province to be in connection with LTV specialists, creating more capacity for critical care.
Across Ontario, many medically stable patients requiring long-term ventilation occupy ICU beds unnecessarily at any given time, placing significant strain on the provincial health care system. This situation leads to substantial financial burdens and contributes to extended wait times for patients needing critical care.
"These patients, though they require assisted ventilation, are medically stable and don't necessarily need all the services of the ICU," says Raj Kohli, Clinical Manager of the PLTVS at West Park. "Integration back into their community is what's best for these patients, as it's better for their overall quality of life, as well as increases critical care capacity in our hospitals."
The Ministry of Health recently announced it will continue to support the PLTVS by providing annualized funding to build on the strategy's progress in managing patients with complex respiratory needs and supporting and coordinating clinical care options for LTV patients closer to home and in the community.
Recognizing the complexity of ventilated patient care, the PLTVS also launched an online portal offering essential education and resources for patients, families and health care professionals, helping to ensure the sustainability of high-quality care across Ontario.
"The next three years will be exciting as the strategy advances Ontario's LTV model of care, develops a specialized curriculum for health care professionals, and launches a remote monitoring system to alert medical teams of deteriorating patients on ventilators in the community," says Dr. Roger Goldstein, Director of Respiratory Medicine at West Park and Provincial Clinical Champion for the PLTVS.
Since returning to the comfort of his own home, Robert said that his quality of life has improved significantly.
"I have family and friends now that I see regularly," he says. "In the hospital, I had visitors, but it never resembled normal life."
While in West Park's transitional care program, Robert received an interprofessional care approach focusing on rehabilitation, training and education and on-going support to his family and caregivers, as well as 24-hour monitoring to ensure he could safely use his assisted ventilation system at home.
Robert now uses a phrenic nerve pacemaker, a surgically implanted device which stimulates the phrenic nerve to help control his breathing by sending electrical signals to the diaphragm.
With permanent funding now in place, PLTVS is set to expand its impact, enhancing care for more patients such as Robert, while also focusing on improving care for non-invasively ventilated individuals.
As the program evolves, it aims to further ease the strain on ICU beds while ensuring ventilator-dependent patients receive high-quality, accessible care closer to home, marking a significant step forward for Ontario's health care system.
