Jennifer Wang1,2, Evan Leibner1,3, Jaime B Hyman4, Sanam Ahmed1,2, Joshua Hamburger4, Jean Hsieh1,5, Neha Dangayach1,6, Pranai Tandon1, Umesh Gidwani1,7, Andrew Leibowitz4, Roopa Kohli-Seth1,2. 1. Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 2. Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 3. Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 4. Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 5. Division of Pulmonary Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 6. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 7. Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has resulted in a dramatic surge in the number of critically ill patients. This was especially true in New York city, the epicenter of the pandemic in the United States. In the present study, a roadmap was proposed for hospitals and health systems to prepare for a surge in critical care capacity. Methods: This was a retrospective review of how Mount Sinai Hospital (MSH) was able to rapidly prepare to handle the COVID-19 pandemic. How MSH, the largest academic hospital within the Mount Sinai Health System, rapidly expanded the intensive care unit (ICU) bed capacity, including creating new ICU beds in traditionally non-critical care areas, expanded the workforce for ICUs, and created guidelines to streamline workflow, is described in this review. Results: MSH expanded from a 1,139-bed quaternary care academic referral hospital with 104 ICU beds to 1,453 beds (27.5% increase) with 235 ICU beds (126% increase) during the pandemic peak in the first week of April 2020. From March to June 2020, with follow-up through October 2020, MSH admitted 2,591 COVID-19-positive patients, 614 to ICUs. Most admitted patients received noninvasive support including a non-rebreather mask, high flow nasal cannula, and noninvasive positive pressure ventilation. Among ICU patients, 68.4% (n=420) received mechanical ventilation; among the admitted ICU patients, 40.7% (n=250) died, and 47.8% (n=294) were discharged alive. Among the patients requiring mechanical ventilation, 55.0% (n=231) died and 43.1% (n=181) were discharged alive from the hospital. Conclusion: : Flexible bed management initiatives; teamwork across multiple disciplines; and development and implementation of guidelines for airway management, cardiac arrest, anticoagulation, vascular access, and proning were critical in streamlining workflow and accommodating the surge in critically ill patients. Non-ICU services and staff were deployed to augment the critical care work force and open new critical care units by leveraging a tiered staffing model. This approach to rapidly expand bed availability and staffing across the system helped provide the best care for the patients and saved lives.
Background: The coronavirus disease 2019 (COVID-19) pandemic has resulted in a dramatic surge in the number of critically illpatients. This was especially true in New York city, the epicenter of the pandemic in the United States. In the present study, a roadmap was proposed for hospitals and health systems to prepare for a surge in critical care capacity. Methods: This was a retrospective review of how Mount Sinai Hospital (MSH) was able to rapidly prepare to handle the COVID-19 pandemic. How MSH, the largest academic hospital within the Mount Sinai Health System, rapidly expanded the intensive care unit (ICU) bed capacity, including creating new ICU beds in traditionally non-critical care areas, expanded the workforce for ICUs, and created guidelines to streamline workflow, is described in this review. Results: MSH expanded from a 1,139-bed quaternary care academic referral hospital with 104 ICU beds to 1,453 beds (27.5% increase) with 235 ICU beds (126% increase) during the pandemic peak in the first week of April 2020. From March to June 2020, with follow-up through October 2020, MSH admitted 2,591 COVID-19-positive patients, 614 to ICUs. Most admitted patients received noninvasive support including a non-rebreather mask, high flow nasal cannula, and noninvasive positive pressure ventilation. Among ICU patients, 68.4% (n=420) received mechanical ventilation; among the admitted ICU patients, 40.7% (n=250) died, and 47.8% (n=294) were discharged alive. Among the patients requiring mechanical ventilation, 55.0% (n=231) died and 43.1% (n=181) were discharged alive from the hospital. Conclusion: : Flexible bed management initiatives; teamwork across multiple disciplines; and development and implementation of guidelines for airway management, cardiac arrest, anticoagulation, vascular access, and proning were critical in streamlining workflow and accommodating the surge in critically illpatients. Non-ICU services and staff were deployed to augment the critical care work force and open new critical care units by leveraging a tiered staffing model. This approach to rapidly expand bed availability and staffing across the system helped provide the best care for the patients and saved lives.