This article describes how a hospital in New York (Weil Cornell) prepared for a surge of critically ill patients and provides a helpful roadmap for centers that are getting getting for a surge of COVID-19 patients.
The hospital’s surge planning included the following:
- initial highest priorities included obtaining an adequate supply of personal protective equipment (PPE) for the staff and
evaluating/expanding intensive care unit (ICU) and ventilator capacity
- developing protocols about clinical decisions around intubation, the use of high-flow
oxygen, infectious disease consultation and cardiac arrest
- minimizing staff exposure by bundling care as much as possible
- using technology to minimize staff exposure to COVID-19 and to facilitate family engagement and end of life discussions
- infection control
- clinical operational challenges
- planning for intensive care unit surge capacity by increasing bed capacity and outsourcing procedures
- support for clinical and nonclinical staff affected by the impact of COVID-19
- using interdisciplinary collaboration and iterative surge planning
as intensive care unit admissions rose
- ensuring clinicians were up to date on literature about COVID-19 patient management and communicated with each other to standardize care through virtual conferences/seminars.
- providing a rapid simulation curriculum focused on pronation and COVID cardiac arrests for both day and night shift
nurses in non-medical ICUs (led by pulmonary and critical care physicians)
- encouraging emergency medicine and hospital medicine physicians to pursue early, honest conversations
with patients and families regarding goals of care and clarifying advance directives. This was supported by access to palliative care and ethicists to help facilitate these conversations.