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. 2025 May;167(5):1371-1387.
doi: 10.1016/j.chest.2024.11.017. Epub 2024 Nov 28.

The Minnesota Critical Care Working Group 2: Crisis Conditions During the COVID-19 Pandemic, July 2021 through March 2022

Sarah M Kesler  1 , Christina Bastin De Jong  2 , Christine Chell  3 , Debra DeBruin  4 , Heidi L Erickson  3 , Kimberly A Goodman  5 , Walter Y James  6 , Jason Kallestad  7 , Tom Klemond  3 , Erin McLachlan  6 , Cheryl Petersen-Kroeber  6 , James Risser  8 , Erin S DeMartino  9 , Alexandra T Waterman  6 , Susan M Wolf  4 , Joel Wu  4 , Clara Zamorano  10 , Karyn D Baum  4 , Daniel Brown  9 , Joshua Cohen  11 , Deanna Diebold  5 , Jennifer A Fischer  12 , Kay Greenlee  13 , John L Hick  4 , Paul A Kettler  14 , Michele LeClaire  15 , Jacob Lyons  13 , Sean MacDonell  6 , Kyle Mairose  7 , Andrea Boehland  2 , Joseph Martinelli  16 , Elizabeth A Miller  17 , David E Niccum  8 , Ronald Reilkoff  4 , Judy Seaberg  6 , Nneka O Sederstrom  3 , Adam Shadiow  18 , Shawn Stoen  19 , Helen Strike  20 , Ken K Maslonka  21 , Jack M Wolf  4 , Jennifer Schoenecker  22 , Jeffrey R Dichter  4 ; Minnesota Critical Care Working Group
Affiliations

The Minnesota Critical Care Working Group 2: Crisis Conditions During the COVID-19 Pandemic, July 2021 through March 2022

Sarah M Kesler et al. Chest. 2025 May.

Abstract

Background: The Minnesota State Healthcare Coordination Center requested that the Minnesota Critical Care Working Group (CCWG) and Ethics Working Group (EWG), comprising interprofessional leaders from Minnesota's 9 largest health systems, plan and coordinate critical care operations during the COVID-19 pandemic, including the fall 2021 surge.

Research question: Can a statewide working group collaboratively analyze real-time evidence to identify crisis conditions and to engage state leadership to implement care processes?

Study design and methods: The CCWG and EWG met via videoconferencing during the severe surge of fall 2021 to analyze evidence and plan for potential crisis care conditions. Five sources of evidence informed their actions: group consensus on operating conditions, federal teletracking data, the Medical Operations Coordination Center (MOCC) patient placement data, and 2 surveys created and distributed to hospitals and health care professionals. The group developed and recommended processes to mitigate the conditions and engaged statewide leadership for support.

Results: Evidence of crisis conditions included rising numbers of patients with COVID-19, tertiary care centers with difficulty accepting transfers (including emergencies), severe emergency department crowding, activation of ICU allocation teams, and low patient placement rate at the Minnesota MOCC. A statewide hospital survey demonstrated numerous staffing adaptations, expansion of telemedicine, and delay of nonemergent procedures. A survey of health care professionals revealed instances of poor patient outcomes, bedside rationing, implicit triage, and moral distress. Leadership engagement resulted in public messaging, although no change in how ICU care was allocated, nor were transfers managed.

Interpretation: The CCWG collected and analyzed evidence demonstrating crisis conditions and health care professional moral distress during the fall 2021 COVID-19 surge. However, the group had a limited impact on care processes. This article analyzes the group's efforts. It includes recommendations for researchers and policy makers.

Keywords: COVID-19; ICU strain; allocation of scarce resources; crisis conditions; crisis management; critical care; nonbeneficial care; surge.

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Conflict of interest statement

Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: S. M. W. has received funding as a consultant on that grant and served as codirector of the Minnesota COVID Ethics Collaborative from 2020 through 2022. D. Debruin has received funding from the Minnesota Department of Health to conduct stakeholder engagement sessions to refine CSC frameworks in the state and served as codirector of the Minnesota COVID Ethics Collaborative from 2020 through 2022. None declared (S. M. K., C. B. D., C. C., H. L. E., K. A. G., W. Y. J., J. K., T. K., E. M., C. P.-K., J. R., E. S. D., A. T. W., J. W., C. Z., K. D. B., D. B., J. C., D. Diebold, J. A. F., K. G., J. L. H., P. A. K., M. L., J. L., S. M., K. M., A. B., J. M., E. A. M., D. E. N., R. R., J. Seaberg, N. O. S., A. S., S. S., H. S., K. K. M., J. M. W., J. Schoenecker, J. R. D.).