Hospital Preparedness for COVID-19: A Practical Guide from a Critical Care Perspective

Abstract

In response to the estimated potential impact of coronavirus disease (COVID-19) on New York City hospitals, our institution prepared for an influx of critically ill patients. Multiple areas of surge planning progressed, simultaneously focused on infection control, clinical operational challenges, ICU surge capacity, staffing, ethics, and maintenance of staff wellness. The protocols developed focused on clinical decisions regarding intubation, the use of high-flow oxygen, engagement with infectious disease consultants, and cardiac arrest. Mechanisms to increase bed capacity and increase efficiency in ICUs by outsourcing procedures were implemented. Novel uses of technology to minimize staff exposure to COVID-19 as well as to facilitate family engagement and end-of-life discussions were encouraged. Education and communication remained key in our attempts to standardize care, stay apprised on emerging data, and review seminal literature on respiratory failure. Challenges were encountered and overcome through interdisciplinary collaboration and iterative surge planning as ICU admissions rose. Support was provided for both clinical and nonclinical staff affected by the profound impact COVID-19 had on our city. We describe in granular detail the procedures and processes that were developed during a 1-month period while surge planning was ongoing and the need for ICU capacity rose exponentially. The approaches described here provide a potential roadmap for centers that must rapidly adapt to the tremendous challenge posed by this and potential future pandemics.

The efficiency in the ordinary hospital bed management in Italy: An in-depth analysis of intensive care unit in the areas affected by COVID-19 before the outbreak

“…For these reasons, the analysis of hospital capacity and the efficiency in the management of its structures before the emergency outbreak provides an important reference point to further explore how the management of the emergency has been carried out. Moreover, on this basis lessons learned outlining structural bottle necks and/or facilitators could give indications on the best way to achieve hospital disaster preparedness in case of a COVID-19 second wave or other possible pandemics [35].…”

The Impact of High-Flow Nasal Cannula Use on Patient Mortality and the Availability of Mechanical Ventilators in COVID-19

“…However, newer evidence should alleviate this worry (33,34) and, as such, institutions who initially disallowed use of HFNC for COVID-19associated respiratory failure have begun to permit it. (35) In the context of a pandemic such as COVID-19, our priorities must shift slightly. No longer can our focus be solely on how to help an individual patient survive and thrive.…”

The roles of a pediatric pulmonologist during the COVID‐19 pandemic

“…Our medical community has been studying COVID-19 practically and academically for several months now, and has accumulated a vast amount of data which is summarized in guidelines, pathways, and algorithms. 3,4 I think that every health care system has the responsibility to prepare appropriate educational materials and pathways, which can be used in case we have to deal with COVID-19 surges again. It seems logical to imagine that our leading medical organizations and societies would contribute to their development.…”