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

Abstract

Background Intensive care units (ICUs) experienced a surge in patient cases during the COVID-19 pandemic. Demand was managed by redeploying healthcare workers (HCWs) and restructuring facilities. The rate of ICU admissions has subsided in many regions, with the redeployed workforce and facilities returning to usual functions. Previous literature has focused on the escalation of ICUs, limited research exists on de-escalation. This study aimed to identify the supportive and operational strategies used for the flexible de-escalation of ICUs in the context of COVID-19. Methods The systematic review was developed by searching eight databases in April and November 2021. Papers discussing the return of redeployed staff and facilities and the training, wellbeing, and operational strategies were included. Excluded papers were non-English and unrelated to ICU de-escalation. Quality was assessed using the mixed methods appraisal tool (MMAT) and authority, accuracy, coverage, objectivity, date, and significance (AACODS) checklist, findings were developed using narrative synthesis and thematic analysis. Findings Fifteen papers were included from six countries covering wellbeing and training themes encompassing; time off, psychological follow-up, gratitude, identification of training needs, missed training catch-up, and continuation of ICU and disaster management training. Operational themes included management of rotas, retainment of staff, division of ICU facilities, leadership changes, traffic light systems, and preparation for re-expansion. Interpretation The review provided an overview of the landscape of de-escalation strategies that have taken place in six countries. Limited empirical evidence was available that evaluated the effectiveness of such strategies. Empirical and evaluative research from a larger array of countries is needed to be able to make global recommendations on ICU de-escalation practices.

Nursing workforce deployment and intensive care unit strain during the COVID-19 pandemic in Victoria, Australia

“…[ 10 ] Internationally, it is well recognised that nurses working to meet the pandemic surge require organisational support to assist their recovery. [ 33 ] It is unclear how the negative impacts on nurses from delivering healthcare in response to the pandemic will be addressed in Victoria. [ 24 ]…”

Stress of conscience of COVID-19 among perianaesthesia nurses having worked in a COVID-ICU during the coronavirus pandemic: an international perspective

“…Differences in the provision of supportive strategies for the nurses in the different counties may have been a factor. Clark et al [ 24 ] found that key supportive strategies include: ensuring that the staff receive time off to rest and recuperate; monitoring and support for the long-term mental health of staff; and ensuring that staff received recognition and gratitude for their service. Staff training needs are also of great importance [ 24 ].…”

“…Clark et al [ 24 ] found that key supportive strategies include: ensuring that the staff receive time off to rest and recuperate; monitoring and support for the long-term mental health of staff; and ensuring that staff received recognition and gratitude for their service. Staff training needs are also of great importance [ 24 ]. Perhaps the Netherlands deployed a more well developed training process and provided ongoing emotional support for its nurses.…”

Healthcare provider experiences during COVID-19 redeployment

“…Redeployment may also initially seem diametrically opposed to a sense of competence as was pointed out by a recent letter to the editor by a group of Spanish psychiatrists [29 ▪ ]. We felt safeguarded by the expectation set to function only at the level of a resident, working under an internist who assumed primary responsibility for all patient management decisions [1 ▪▪ ,30]. In this way, we were relieved to never feel out of our depth in medicine, while at the same time our trained skills as psychiatrists turned out to be valuable to the COVID service.…”