Critical Care Surge Capacity in U.S. Hospitals: Strategies for Responding to the COVID-19 Pandemic

Abstract

he coronavirus disease 2019 (COVID-19) outbreak is straining U.S. hospital and health care systems. In late March 2020, the United States surpassed China as the country with the most confirmed COVID-19 cases. Experiences in New York City, an outbreak epicenter, show that there will likely be high demand for critical care resources across the United States in systems that already are strained at baseline.RAND researchers assembled a list of strategies to help U.S. hospitals create critical care surge capacity. The list was created using a review of scientific literature about past outbreaks and the current COVID-19 pandemic, a survey of frontline clinicians conducted in collaboration with the American College of Emergency Physicians, and two roundtables conducted via teleconference with leading emergency and critical care physicians and public health and preparedness experts from around the country.The strategies are organized into two tiers:• Tier 1 strategies to build contingency capacity include adaptations to medical care spaces, staffing constraints, and supply shortages without significant impact on medical care delivery. Strategies might include converting stepdown, post-anesthesia care unit (PACU) or operating room beds to intensive care unit (ICU) beds, drawing on emergency department and PACU nurses not on shift for ICU care, and KEY FINDINGSRAND researchers developed a tool to help hospitals create critical care surge capacity to respond to COVID-19.The tool allows hospitals to assess alternative strategies for creating this capacity and to identify which factors-space, staff, and equipment (such as ventilators)-are key to increasing the number of patients hospitals can treat.An illustrative analysis examined critical care capacity in each of the ten FEMA regions in the United States. In most of these regions, the number of ventilators was the key limiting factor.

Intubation and Ventilation Challenges in COVID-19 Patients: Review Article

“…They should make an evaluation regarding their ability to manage the cases in the hospital in terms of space, healthcare staff and medical supplies. Standard crisis protocols may help with the management of space, medical resources, and human resources in addition to helping with the treatment of patients who are more gravely ill (20) .…”

“…ICU physician leads usually employ a pyramidal organisational structure, with the most experienced doctor being a leader of a group of medical healthcare team with different specialties and experience in ICU and critical care. This team includes nurses, clinical pharmacists, fellows, attending physicians, residents and physician assistants (18,(20)(21)(22) . These qualified but inexperienced carers may be in charge of a lower layer of extenders, such as medical specialists from several professions or other doctors in advanced practice, who are less adept at delivering basic care (18) .…”

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“…The implications of Figure 5 to surge capacity planning should be apparent, 4 that is, CCU bed demand does fluctuate over time and planning at the 'average' is misleading. Indeed, during the COVID-19 pandemic countries in Figure 1 with lower CCU bed provision will have had little to no surge capacity.…”

“…2 The review by Murthy and Wunsch revealed that critical care unit (CCU) numbers in different countries vary enormously, 3 and for sometimes obscure reasons. During COVID-19 critical care capacity was stretched even in parts of the USA, 4 which is recognised as a country with high critical care capacity. 5 It has also highlighted the need for methods which allow different countries to assess their level of critical care capacity relative to other countries using a like-for-like basis.…”

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