COVID-19 and the Intensive Care Unit: Coordinating a Multisite Intensive Care Unit Ramp-up Strategy in Singapore

Abstract

Letter to the Editor Dear Editor, On 11 March 2020, the World Health Organization declared COVID-19 a global pandemic. 1 Since then, COVID-19 cases have risen exponentially in Singapore, 2 resulting in a corresponding need to rapidly increase our national treatment capacity, especially for patients requiring intensive care. With direction from Singapore's Ministry of Health (MOH), Tan Tock Seng Hospital (TTSH) worked together with its affiliated institution, National Centre of Infectious Diseases (NCID), to comprehensively plan to increase ICU capacity across the 2 institutions. NCID was purpose-built to treat patients with infectious diseases and to shoulder Singapore's outbreak response with peacetime capacity of 330 beds and flexibility to ramp-up to more than 500 beds. 3 NCID is located adjacent to TTSH-one of Singapore's largest tertiary hospitals, with a large capacity of over 1,500 beds. NCID is currently the frontline healthcare institution for the screening and treatment of COVID-19 patients in Singapore. 4 A decision was made from the onset to streamline all COVID-19 work processes within TTSH-NCID. Since January 2020, all COVID-19 patients requiring intensive care in TTSH-NCID were managed within NCID's 2 ICU wards. i TTSH's 4 ICU wards (Medical, Cardiac, Surgical and Neuroscience) continued to treat all non-COVID-19 'business-as-usual' (BAU) patients. As national cases steadily rose throughout March, and in anticipation of a potential exponential increase, TTSH-NCID (with direction from MOH) formulated an integrated plan to increase ICU capacity. Although TTSH-NCID's target ICU capacity was aligned to MOH's national objectives, TTSH-NCID planned to progressively ramp-up in phases according to realtime utilisation and demand. This plan was executed in April, as national cases started to rise exponentially. The ramp-up in Outbreak ICU (OICU) capacity to treat COVID-19 patients was achieved via 3 phases: (1) converting 2 BAU ICU wards in TTSH into OICU wards, (2) repurposing COVID-19 General Wards (GWs) in i NCID has a capacity of 38 ICU beds, of which only 10 are operational during peacetime.

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

“…A summary of the key characteristics of the included papers can be found in Table 2 . Of the 15 papers included, two were based on empirical data, ten were based on data from case studies, commentary articles or letters to the editor, 16 , 17 , 18 , 19 , 20 , 21 , 22 , 24 , 29 and three were guidelines on how to manage the de-escalation of ICUs. 25 , 26 , 28 The included papers were from the UK ( n = 6), the USA ( n = 4), Singapore ( n = 2), China ( n = 1), Iran ( n = 1), and Australia ( n = 1).…”

“… 22 Commentary article Alder Hey Children's Hospital, Liverpool, UK Trainees Operational strategies for workforce AACODS: 6/6 Caroselli 24 Case study Veterans Affairs New York harbour Healthcare System, New York, USA ICU and non-ICU nurses Wellbeing and training strategies AACODS: 4.5/6 Yau et al. 29 Letter to the Editor Tan Tock Seng Hospital and National Centre of Infectious Diseases, Singapore N/A Operational strategies for facilities AACODS: 4/6 Lord et al. 17 Case study NYU Langone-Brooklyn Hospital, New York, USA Neurology staff Operational strategies for workforce and facilities AACODS: 5.5/6 Panayiotou et al.…”

“…Some of the papers documented similar approaches to the traffic light system to manage the return of redeployed staff, for de-escalating the ICU facilities. 25 , 29 Yau et al. 29 discussed, how the ICU facilities were de-escalated in 3 phases.…”

“…25 , 29 Yau et al. 29 discussed, how the ICU facilities were de-escalated in 3 phases. The first two phases included separating the ICUs between two healthcare settings, so only one remained open for COVID-19 admissions.…”

“…15 With the decline in ICU patients, many of the redeployed workforce and temporary ICUs could return to usual functions, and numerous publications have documented how these processes have occurred in different hospital settings. 8 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 Since the initial decline, many countries have faced recuring waves of COVID-19 infections and ICU admissions. 15 This repetitive surge in need for ICU capacity followed by de-escalation is likely to continue for some time whilst variants of SARS-CoV-2 continue to circulate throughout the globe.…”