Flow-Sizing Critical Care Resources

Abstract

Objectives: To describe the factors affecting critical care capacity and how critical care organizations (CCOs) within academic centers in the U.S. flow-size critical care resources under normal operations, strain, and surge conditions.

Data sources: PubMed, federal agency and American Hospital Association reports, and previous CCO survey results were reviewed.

Study selection: Studies and reports of critical care bed capacity and utilization within CCOs and in the United States were selected.

Data extraction: The Academic Leaders in the Critical Care Medicine Task Force established regular conference calls to reach a consensus on the approach of CCOs to "flow-sizing" critical care services.

Data synthesis: The approach of CCOs to "flow-sizing" critical care is outlined. The vertical (relation to institutional resources, e.g., space allocation, equipment, personnel redistribution) and horizontal (interdepartmental, e.g., emergency department, operating room, inpatient floors) integration of critical care delivery (ICUs, rapid response) for healthcare organizations and the methods by which CCOs flow-size critical care during normal operations, strain, and surge conditions are described. The advantages, barriers, and recommendations for the rapid and efficient scaling of critical care operations via a CCO structure are explained. Comprehensive guidance and resources for the development of "flow-sizing" capability by a CCO within a healthcare organization are provided.

Conclusions: We identified and summarized the fundamental principles affecting critical care capacity. The taskforce highlighted the advantages of the CCO governance model to achieve rapid and cost-effective "flow-sizing" of critical care services and provide recommendations and resources to facilitate this capability. The relevance of a comprehensive approach to "flow-sizing" has become particularly relevant in the wake of the latest COVID-19 pandemic. In light of the growing risks of another extreme epidemic, planning for adequate capacity to confront the next critical care crisis is urgent.

Figure 1.

Factors affecting critical care capacity. APPs = advanced practice providers, CRNAs = certified registered nurse anesthetists, ECMO = extracorporeal membrane oxygenation, EHR = electronic health record, ER = emergency department, HFOT = high-flow oxygen therapy, IMU = intermediate medical unit, PACU = post-anesthesia care unit, PPE = personal protective equipment, PT = patient, RN = registered nurse, RTs = respiratory therapists.

Figure 2.

Tele-ICU and tele-critical care service under normal and surge conditions.