Breaking Silos: The Team-Based Approach to Coronavirus Disease 2019 Pandemic Staffing

Anderson, Brett R.; Ivascu, Natalia S.; Brodie, Daniel; Weingarten, Jeremy A.; Manoach, Seth; Smith, Anthony; Millerman, Konstantin; Yip, Natalie; Su, Grace; Kleinschmidt, Christa; Khusid, Felix; Olson, Murray; Hochman, Beth; Hill, Laureen L.

doi:10.1097/cce.0000000000000265

Cited by 15 publications

(21 citation statements)

References 5 publications

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“…In this study period, when hospital capacity was severely strained (2), there were 2,628 eligible patients admitted to CUIMC with COVID-19 ( Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Since its emergence, COVID-19, the novel infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has infected more than 242 million individuals in 192 countries, resulting in greater than 4.9 million deaths (1). In New York City, an epicenter of the COVID-19 pandemic in the spring of 2020, hospitals faced a surge of critically ill patients and crisis conditions (2). Within the landscape of high reported mortality rates, significant resource scarcity, fear of infection, and lack of personal protective equipment (PPE), providers grappled during goals-of-care discussions with addressing the appropriateness of performing cardiopulmonary resuscitation (CPR) in patients with COVID-19 who suffered in-hospital cardiac arrest (IHCA) (3).…”

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confidence: 99%

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In COVID-19 Patients Who Suffer In-Hospital Cardiac Arrest, Cardiopulmonary Resuscitation Outcomes May Be Impacted by Arrest Etiology and Local Pandemic Conditions

Murphy

Nishikawa

Char

et al. 2022

Critical Care Explorations

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OBJECTIVES: The utility and risks to providers of performing cardiopulmonary resuscitation after in-hospital cardiac arrest in COVID-19 patients have been questioned. Additionally, there are discrepancies in reported COVID-19 in-hospital cardiac arrest survival rates. We describe outcomes after cardiopulmonary resuscitation for in-hospital cardiac arrest in two COVID-19 patient cohorts. DESIGN: Retrospective cohort study. SETTING: New York-Presbyterian Hospital/Columbia University Irving Medical Center in New York, NY. PATIENTS: Those admitted with COVID-19 between March 1, 2020, and May 31, 2020, as well as between March 1, 2021, and May 31, 2021, who received resuscitation after in-hospital cardiac arrest. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Among 103 patients with coronavirus disease 2019 who were resuscitated after in-hospital cardiac arrest in spring 2020, most self-identified as Hispanic/Latino or African American, 35 (34.0%) had return of spontaneous circulation for at least 20 minutes, and 15 (14.6%) survived to 30 days post-arrest. Compared with nonsurvivors, 30-day survivors experienced in-hospital cardiac arrest later (day 22 vs day 7; p = 0.008) and were more likely to have had an acute respiratory event preceding in-hospital cardiac arrest (93.3% vs 27.3%; p < 0.001). Among 30-day survivors, 11 (73.3%) survived to hospital discharge, at which point 8 (72.7%) had Cerebral Performance Category scores of 1 or 2. Among 26 COVID-19 patients resuscitated after in-hospital cardiac arrest in spring 2021, 15 (57.7%) had return of spontaneous circulation for at least 20 minutes, 3 (11.5%) survived to 30 days post in-hospital cardiac arrest, and 2 (7.7%) survived to hospital discharge, both with Cerebral Performance Category scores of 2 or less. Those who survived to 30 days post in-hospital cardiac arrest were younger (46.3 vs 67.8; p = 0.03), but otherwise there were no significant differences between groups. CONCLUSIONS: Patients with COVID-19 who received cardiopulmonary resuscitation after in-hospital cardiac arrest had low survival rates. Our findings additionally show return of spontaneous circulation rates in these patients may be impacted by hospital strain and that patients with in-hospital cardiac arrest preceded by acute respiratory events might be more likely to survive to 30 days, suggesting Advanced Cardiac Life Support efforts may be more successful in this subpopulation.

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“…In this study period, when hospital capacity was severely strained (2), there were 2,628 eligible patients admitted to CUIMC with COVID-19 ( Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

In COVID-19 Patients Who Suffer In-Hospital Cardiac Arrest, Cardiopulmonary Resuscitation Outcomes May Be Impacted by Arrest Etiology and Local Pandemic Conditions

Murphy

Nishikawa

Char

et al. 2022

Critical Care Explorations

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“…In her article, Aznavorian (2020) suggested many approaches and strategies that help to ensure the provision of patient care during a crisis, such as quick evaluation of the available staffing as the initial step In one of the largest hospitals in New York City, a multidisciplinary leadership team created “a novel, intercampus leadership team, inclusive of hospital administrators, physicians, nurses, respiratory therapists, and facilities experts.” In their model, they replaced the routine critical care approach with a supervisory or managerial approach to help in delivering skilled care to more patients at the same time by incorporating nurses from other areas into the ICU as new teams with a different approach. Their experience and lessons learned are elaborately narrated in their article (Anderson et al., 2020). Another study discussed approaches and recommendations based on evidence‐based resources regarding nursing staff expansion and deployment.…”

Section: Discussionmentioning

confidence: 99%

Staffing critical care with nurses amid the COVID‐19 crisis: Strategies and plans

Mhawish

2021

International Nursing Review

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To describe a nursing staffing surge model in critical care units that can be used during a pandemic or crisis. This model may give useful guidance for hospitals or centers that must immediately react in response to the devastating challenges introduced by disease outbreaks. Background: During the COVID-19 pandemic, many hospitals were challenged to maintain the quality of care and safe practice in critical care units while accommodating the daily rapidly increasing number of infected cases that needed critical care. The nursing staffing shortage in critical care units and its consequences were among the top issues to deal with. Method: This is a descriptive study about our experience in preparing for nursing staffing in critical care as a part of the COVID-19 surge plan. We have used evidencebased strategies to design our team-based model for staffing during the COVID-19 pandemic. Results:The team-based model for staffing during the COVID-19 pandemic had shown success in dealing with the acute shortage of nursing staff in critical care units. We had implemented other additional supportive strategies to help enhance this staffing. Conclusion:With the support of available evidence-based resources and on-the-fly preparation and training, we were able to augment the tremendous increase in patient influx during the pandemic using the team-based model. Implications for nursing management: The team-based approach and other strategies included in this article can help support critical care units with staff during crises. However, we strongly recommend developing a nursing deployment policy that makes staff redeployment and re-allocation smoother, whenever needed.

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“…12,13 Anecdotal reports from hospitals experiencing surges suggested a patchwork of responses and solutions. [14][15][16][17][18][19][20][21] However, robust data on how hospitals actually responded to the surge in demand for critical care services during this period are lacking. To better understand this issue, we performed a structured survey of a representative sample of US hospitals asking what steps they planned for or undertook during the first phase of the COVID-19 pandemic.…”

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confidence: 99%

Actions Taken by US Hospitals to Prepare for Increased Demand for Intensive Care During the First Wave of COVID-19

Kerlin¹,

Costa²,

Davis³

et al. 2021

Chest

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Background The coronavirus disease 2019 (COVID-19) pandemic placed considerable strain on critical care resources. How United States (U.S.) hospitals responded to this crisis is unknown. Research question What actions did U.S. hospitals take to prepare for a potential surge in demand for critical care services in the context of the COVID-19 pandemic? Study design and methods From September to November 2020 we surveyed the chief nursing officers of a representative sample of U.S. hospitals regarding organizational actions taken to increase or maintain critical care capacity during the pandemic. We calculated weighted proportions of hospitals for each potential action in order to create estimates across the entire population of U.S. hospitals, accounting for both the sampling strategy and non-response. We also examined whether the types of actions taken varied by the cumulative regional incidence of COVID-19 cases. Results We received responses from 169 of 540 surveyed U.S. hospitals (response rate: 31.3%). Almost all hospitals canceled or postponed elective surgeries (96.7%) and non-surgical procedures (94.8%). Few hospitals created new medical units in areas not typically dedicated to health care (12.9%), and almost none adopted triage protocols (5.6%) or protocols to connect multiple patients to a single ventilator (4.8%). Actions to increase or preserve intensive care unit (ICU) staff, including use of ICU telemedicine, were highly variable, without any single dominant strategy. Hospitals experiencing higher incidence of COVID-19 did not consistently take different actions compared to hospitals facing lower incidence. Interpretation Responses of hospitals to the mass need for critical care services due to the COVID-19 pandemic were highly variable. Most hospitals canceled procedures to preserve ICU capacity and scaled up ICU capacity using existing clinical space and staffing. Future work linking hospital response to patient outcomes can inform planning for additional surges of this pandemic or other events in the future.

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Breaking Silos: The Team-Based Approach to Coronavirus Disease 2019 Pandemic Staffing

Cited by 15 publications

References 5 publications

In COVID-19 Patients Who Suffer In-Hospital Cardiac Arrest, Cardiopulmonary Resuscitation Outcomes May Be Impacted by Arrest Etiology and Local Pandemic Conditions

In COVID-19 Patients Who Suffer In-Hospital Cardiac Arrest, Cardiopulmonary Resuscitation Outcomes May Be Impacted by Arrest Etiology and Local Pandemic Conditions

Staffing critical care with nurses amid the COVID‐19 crisis: Strategies and plans

Actions Taken by US Hospitals to Prepare for Increased Demand for Intensive Care During the First Wave of COVID-19

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