Design for Implementation of a System-Level ICU Pandemic Surge Staffing Plan

Abstract

Background: The current coronavirus disease 2019 pandemic is causing significant strain on ICUs worldwide. Initial and subsequent regional surges are expected to persist for months and potentially beyond. As a result of this, as well as the fact that ICU provider staffing throughout the United States currently operate at or near capacity, the risk for severe and augmented disruption in delivery of care is very real. Thus, there is a pressing need for proactive planning for ICU staffing augmentation, which can be implemented in response to a local surge in ICU volumes.

Methods: We provide a description of the design, dissemination, and implementation of an ICU surge provider staffing algorithm, focusing on physicians, advanced practice providers, and certified registered nurse anesthetists at a system-wide level.

Results: The protocol was designed and implemented by the University of Pittsburgh Medical Center's Integrated ICU Service Center and was rolled out to the entire health system, a 40-hospital system spanning Pennsylvania, New York, and Maryland. Surge staffing models were developed using this framework to assure that local needs were balanced with system resource supply, with rapid enhancement and expansion of tele-ICU capabilities.

Conclusions: The ICU pandemic surge staffing algorithm, using a tiered-provider strategy, was able to be used by hospitals ranging from rural community to tertiary/quaternary academic medical centers and adapted to meet specific needs rapidly. The concepts and general steps described herein may serve as a framework for hospital and other hospital systems to maintain staffing preparedness in the face of any form of acute patient volume surge.

Keywords: advanced practice providers; coronavirus disease 2019; disaster; pandemic; staffing; workforce.

Figure 1.

Coronavirus disease 2019 (COVID-19) surge capacity working definitions. Adapted from Crisis Standards of Care (1). APP = advanced practice provider.

Figure 2.

A framework for outlining, contingency, and crisis surge response. Reprinted from Christian et al (5). PACU = post-anesthesia care unit.

Figure 3.

In this model, care for each of four groups of 24 patients is provided by a team managed by a critical care-trained physician. Our tired staffing tool focuses on the top two provider level layers of the above pyramid (inclusive of the critical care physician level). Reproduced with permission from Halpern and Tan (10). Copyright© 2020 the Society of Critical Care Medicine. APP = advanced practice provider, CAA = certified anesthesiology assistant, CRNA = certified registered nurse anesthetist, DO = doctor of osteopathic medicine, MD = medical doctor, RT = respiratory therapist.

Figure 4.

The University of Pittsburgh Medical Center (UPMC) ICU pandemic surge staffing algorithm. COVID-19 = coronavirus disease 2019.

Figure 5.

Representative community hospital surge staffing plan. APP = advanced practice provider, COVID-19 = coronavirus disease 2019, CRNA = certified registered nurse anesthetist.