For most level 1 trauma centers and tertiary care facilities, operating intensive care units at 80 percent to 90 percent capacity is standard — even before the COVID-19 pandemic hit. But the intensity and duration of caring for severely ill patients during the pandemic have presented unique challenges for hospitals.
Becker's spoke with two healthcare leaders in Massachusetts and Florida about ICU capacity challenges, staffing best practices and more. Sound bites of the conversations are below.
Editor's note: Responses have been lightly edited for length and clarity.
On expanding ICU capacity amid COVID-19 surges:
Kathryn Hibbert, MD, a pulmonologist and critical care specialist at Boston-based Massachusetts General Hospital: "During the surge this spring, we essentially doubled our ICU capacity, but we also shifted all of that capacity to take care of only one type of patient. So we had a few patients who were not COVID-19 patients, but almost all of the beds we normally use for different conditions were converted to take care of COVID-19 patients. In some ways you could say we doubled our ICU capacity, but in other ways you could say we quintupled our respiratory failure capacity because we used all of those beds for just one condition. Normally the medical ICU runs very close to capacity, but there are other ICUs that usually have some beds open if we need to send them a spillover patient. During the COVID-19 surge, all of our ICUs were very full, and we were using surge ICUs. So it was both the intensity and the duration that were very atypical."
Kelly Cullen, executive vice president and COO at Tampa (Fla.) General Hospital: "Tampa General has 146 ICU beds year-round. During normal, non-COVID-19 times, our ICU runs at about 92 percent occupancy since we are the only level 1 trauma center in the area. Very early on in our COVID-19 response, we converted two ICUs to negative-pressure rooms. We also developed dedicated COVID-19 units that are broken down into three levels of care. Our whole COVID-19 response has been a very phased approach designed to account for best- and worst-case scenarios. What it looked like in March is very different from what it looks like today."
On the biggest ICU challenges amid the pandemic:
Dr. Hibbert: "Having enough adequately trained staff in the ICU was the biggest challenge this spring, along with staff fatigue and burnout. You have to ensure the ICU nurses, critical care physicians and respiratory therapists are not overworked and have a chance to rejuvenate outside the hospital and take a break when they need to."
Ms. Cullen: "I think the biggest challenge is protecting the well-being of the entire interdisciplinary team. It's been five months; they're tired. This is a population that is labor intensive, especially with COVID-19 patients in the ICU. Having said that, our team has done an amazing job. We've had surge plans in place for a long time to be ready for things like this. I think the readiness and team engagement has been the biggest reason we've been able to manage this situation so smoothly."
Advice for other hospitals:
Dr. Hibbert: "The biggest advice I would have is to plan ahead for the worst-case scenario so you don't have to scramble in the last minute. Work hard to break down the silos that happen between groups within a hospital so everyone is communicating across different specialties or departments. Make sure that you have a coordinated effort to bring all the right people into the room so that if you do have to create a new ICU space, you can address every piece of that, whether it is finding an ICU nurse to take care of the patient, making sure you have the right supplies in that space or making sure you have a staff rotation schedule to ensure people get adequate rest."
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