Mary Jarzebowski1, Tom Curran1, Megan Dorsey1, William Cederquist1, Dru Claar1, Elisa Derrig1, Weston Dick1, Katrina Push1, Mark Hausman1, Tamar Lake1. 1. , and are Staff Physicians; is Director, Surgical Intensive Care Unit; is Director, Medical Intensive Care Unit; is Chief CRNA, Section of Anesthesiology; is Chief, Facilities Management Service; is a Nurse Manager, Post-Anesthesia Care Unit; is Chief of Staff; and is Chief, Section of Anesthesiology and Perioperative Care; all at the Veterans Affairs Ann Arbor Healthcare System in Michigan. Mary Jarzebowski is a Clinical Assistant Professor; Tom Curran, Megan Dorsey, and William Cederquist are Clinical Instructors; Mark Hausman is an Assistant Professor; all in the Department of Anesthesiology, University of Michigan. Dru Claar is a Clinical Assistant Professor, Department of Pulmonary and Critical Care Medicine at the University of Michigan. Mark Hausman is Assistant Dean for Veterans Affairs, University of Michigan Medical School.
Abstract
OBJECTIVES: To prepare for the predicted surge of patients with COVID-19 in Southeast Michigan, the US Department of Veterans Affairs Ann Arbor Healthcare System engineered, built, and staffed a 12-bed intensive care unit (ICU) from the existing postanesthesia care unit (PACU). OBSERVATIONS: Considerations including floor planning, reversal of airflow, strict airborne precautions, sealing off a dedicated nursing station, and developing an infection control plan in an open care unit. A staffing model was created that included anesthesiologist intensivists, advanced practice providers, residents, certified registered nurse anesthetists, and perioperative nurses working alongside ICU trained nurses. Challenges arose in infection control, communication, mechanical ventilation using anesthesia machines, providing renal replacement therapy, and maintaining patient privacy in an open unit. CONCLUSIONS: This article describes the setup, challenges, and solutions that allowed the creation of the PACU-ICU to help serve veterans and civilians during a time of unprecedented strain on the health care system due to COVID-19.
OBJECTIVES: To prepare for the predicted surge of patients with COVID-19 in Southeast Michigan, the US Department of Veterans Affairs Ann Arbor Healthcare System engineered, built, and staffed a 12-bed intensive care unit (ICU) from the existing postanesthesia care unit (PACU). OBSERVATIONS: Considerations including floor planning, reversal of airflow, strict airborne precautions, sealing off a dedicated nursing station, and developing an infection control plan in an open care unit. A staffing model was created that included anesthesiologist intensivists, advanced practice providers, residents, certified registered nurse anesthetists, and perioperative nurses working alongside ICU trained nurses. Challenges arose in infection control, communication, mechanical ventilation using anesthesia machines, providing renal replacement therapy, and maintaining patient privacy in an open unit. CONCLUSIONS: This article describes the setup, challenges, and solutions that allowed the creation of the PACU-ICU to help serve veterans and civilians during a time of unprecedented strain on the health care system due to COVID-19.
Authors: Francesco Mojoli; Silvia Mongodi; Giuseppina Grugnetti; Alba Muzzi; Fausto Baldanti; Raffaele Bruno; Antonio Triarico; Giorgio Antonio Iotti Journal: Anesthesiology Date: 2020-07 Impact factor: 7.892