Hospital Preparedness for COVID-19: A Practical Guide from a Critical Care Perspective

Abstract

In response to the estimated potential impact of coronavirus disease (COVID-19) on New York City hospitals, our institution prepared for an influx of critically ill patients. Multiple areas of surge planning progressed, simultaneously focused on infection control, clinical operational challenges, ICU surge capacity, staffing, ethics, and maintenance of staff wellness. The protocols developed focused on clinical decisions regarding intubation, the use of high-flow oxygen, engagement with infectious disease consultants, and cardiac arrest. Mechanisms to increase bed capacity and increase efficiency in ICUs by outsourcing procedures were implemented. Novel uses of technology to minimize staff exposure to COVID-19 as well as to facilitate family engagement and end-of-life discussions were encouraged. Education and communication remained key in our attempts to standardize care, stay apprised on emerging data, and review seminal literature on respiratory failure. Challenges were encountered and overcome through interdisciplinary collaboration and iterative surge planning as ICU admissions rose. Support was provided for both clinical and nonclinical staff affected by the profound impact COVID-19 had on our city. We describe in granular detail the procedures and processes that were developed during a 1-month period while surge planning was ongoing and the need for ICU capacity rose exponentially. The approaches described here provide a potential roadmap for centers that must rapidly adapt to the tremendous challenge posed by this and potential future pandemics.

Keywords: ICUs; SARS virus; pandemics.

Figure 1.

(A) New coronavirus disease (COVID-19) cases. (B) Total COVID-19 hospitalizations (blue) and ICU hospitalizations (orange) in New York State from March 14, 2020, to April 8, 2020. Reprinted by permission from Reference .

Figure 2.

(A) Photos of ventilator screens and intravenous infusion pumps outside patient rooms. (B) Photo of patient data on the glass door of a patient’s room. ABG = arterial blood gas; GTTS = guttae.

Figure 3.

Each symbol denotes a patient with coronavirus disease (COVID-19). In the presurge period, patients were placed according to bed availability. Phase 1: unit readiness with partial COVID-19 census. Phase 2: start of ICU cohorting and creation of a new unit to displace patients without COVID-19 requiring specialty care. Phase 3: exhaustion of traditional ICU capacity. Patients who were not positive for COVID-19 were primarily postsurgical patients who were grouped together. Neg Pressure Proc room = negative pressure procedure room.