Response to 'A critical care pandemic staffing framework in Australia'.

Dear Editor,

With great interest we have read the paper by Marshall et al. that provides valuable tools and recommendations to expand multidisciplinary workforce capacity in critical care. These recommendations can be valuable in every country as a framework for expanding the workforce in the intensive care unit (ICU). In our own hospital, during the first wave, we managed to upscale our ICU capacity to more than 250% and asked our colleagues from other departments with some sort of ICU background (surgery, anaesthesiology, emergency room, and neurology) to help us in these difficult times. Currently, during the second wave in the Netherlands, we reach the same upscale in capacity as during the first wave. In addition, we reached out to former nursing colleagues, retired colleagues, to assist our own nursing staff in the care for critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

One of the most intriguing problems that arise is how to plan or model how much staff you need. As an example, we will illustrate this problem with the recent systematic review performed by Wynants et al. about prediction models for diagnosis and prognosis in patients with SARS-CoV-2 infection. In their study, they reviewed 31 prediction models that each focussed on different prediction aspects: (i) risk of hospital admission for SARS-CoV-2 infection in the general population, (ii) diagnosis of SARS-CoV-2 pneumonia and related events, and (iii) predicting outcomes (such as mortality, ICU admittance, and disease progression). Most of the models that were reviewed were constructed using data from Chinese studies. Normally, when the clinical course of a disease is known, you can construct a robust model, and this might be used to calculate the inflow and outflow of patients in the ICU. Good example is the study carried out by Stepaniak and Pouwels about balancing the demand and supply in cardiothoracic surgical practice. Unfortunately, we are still learning about the clinical course of patients with SARS-CoV-2 infection, and therefore, it is really difficult to assess how many ICU beds you need in the hospital, despite the efforts done and published in the literature.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of Interest

None.