The Effects of ICU Crisis Reorganization on Outcomes in Patients Not Infected With Coronavirus Disease 2019 During the Initial Surge of the Coronavirus Disease 2019 Pandemic

Abstract

Objectives: To determine if ICU reorganization due to the coronavirus disease 2019 pandemic affected outcomes in critically ill patients who were not infected with coronavirus disease 2019. Design: This was a Before-After study, with coronavirus disease 2019-induced ICU reorganization as the intervention. A retrospective chart review of adult patients admitted to a reorganized ICU during the coronavirus disease 2019 surge (from March 23, 2020, to May 06, 2020: intervention group) was compared with patients admitted to the ICU prior to coronavirus disease 2019 surge (from January 10, 2020, to February 23, 2020: before group). Setting: High-intensity cardiac, medical, and surgical ICUs of a community hospital in metropolitan Missouri. PATIENTS: All patients admitted to the ICU during the before and intervention period were included. Patients younger than 18 years old and those admitted after an elective procedure or surgery were excluded. Patients with coronavirus disease 2019 were excluded. Interventions: None. Measurements and Main Results: We identified a total of 524 eligible patients: 342 patients in the before group and 182 in the intervention group. The 28-day mortality was 25.1% (86/342) and 28.6% (52/182), respectively (p = 0.40). The ICU length of stay, ventilator length of stay, and ventilator-free days were similar in both groups. Rates of patient adverse events including falls, inadvertent endotracheal tube removal, reintubation within 48 hours of extubation, and hospital acquired pressure ulcers occurred more frequently in the study group (20 events, 11%) versus control group (12 events, 3.5%) (p = 0.001). Conclusions: Twenty-eight-day mortality, in patients who required ICU care and were not infected with coronavirus disease 2019, was not significantly affected by ICU reorganization during a pandemic.

A systematic review of de-escalation strategies for redeployed staff and repurposed facilities in COVID-19 intensive care units (ICUs) during the pandemic

“…This contrasts the heavy reporting of strategies used to escalate facilities during the COVID-19 surge. 5 , 6 , 7 , 8 …”

“…Many settings expanded ICU facilities by developing temporary ICUs in operating theatres that were not in use as elective procedures had been cancelled, by converting paediatric ICUs (PICU) into adult ICUs as the infection had not affected children as severely as adults, or by outsourcing patients to private healthcare providers. 5 , 6 , 7 , 8 To fulfil the workforce requirements, medical professionals were redeployed from the areas of care that were not in high demand such as surgical departments and PICUs. Additionally former HCWs and trainee HCWs were redeployed.…”

Comparing the Occurrence of Healthcare-Associated Infections in Patients with and without COVID-19 Hospitalized during the Pandemic: A 16-Month Retrospective Cohort Study in a Hospital Intensive Care Unit

“…Nevertheless, during the fourth period, multivariable analysis revealed a similar occurrence of HAIs in the two subgroups, suggesting that the psychological effect of the vaccination campaign and a better organization of the ICU ward, which had already faced the previous wave of the pandemic, may have limited cross-contamination among COVID-19 patients [ 41 ]. Hence, since these findings suggest that healthcare personnel took a different approach to managing these patients during the pandemic and that this may have had a significant role in preventing HAI acquisition, a proper reorganization and restructuring of the ICU should be planned to ensure adequate healthcare delivery in emergency situations [ 5 ].…”

“…The coronavirus disease 2019 (COVID-19) pandemic has imposed many challenges on healthcare systems worldwide [ 1 ]. On the one hand, healthcare facilities have had to face an increasing number of COVID-19 patients, who often required hospital admission [ 2 ]; on the other hand, they had to ensure healthcare delivery for non-COVID-19 patients, who continued to need care [ 3 , 4 , 5 ]. Healthcare activities were rapidly reorganized, and some wards, especially intensive care units (ICUs), had to increase their capacity [ 6 , 7 ].…”

Impact of ICU strain on outcomes

“…Although recommended as part of emergency preparedness actions, these efforts to address the structural components of ICU strain were highly variable across clinical centers in both the United States and the world, thereby adding to the gap in knowledge about how strain truly affected mortality and other outcomes [28,34]. Though we have limited causal data on the differential impact of surge actions and resource availability on patient outcomes during the COVID-19 pandemic [25,37], previous studies have highlighted the link between ICU strain and critical care outcomes in both normal and surge conditions [10,20,21].…”