Critical Care Surge Response Strategies for the 2020 COVID-19 Outbreak in the United States

Abir, Mahshid; Nelson, Christopher; Chan, Edward W.; Al-Ibrahim, Hamad; Cutter, Christina; Patel, Krunalkumar; Bogart, Andy

doi:10.7249/rra164-1

Cited by 44 publications

(46 citation statements)

References 20 publications

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“…At the peak of a surge, hospitals may be forced to adopt "crisis standards of care" 74 and assess the available physical space, staff manpower, and supplies they have on hand to care for their patient burden 75 . Crisis standard guidelines assist in the management of a high volume of high acuity patients and can include guidance on management of space and resources 75 . However, they guidelines do not always provide detailed instruction on adapting staffing in the intensive care unit to deliver the best care to the maximum number of patients.…”

Section: Mechanical Ventilation Is More Than the Ventilatormentioning

confidence: 99%

“…Every critically ill patient with COVID-19 should have oversight by an attending intensivist, whether in person or via telemedicine. Physician leads on ICU teams generally follow a pyramid model with the most experienced critical care physician at the top of the pyramid overseeing a large number of critical-care experienced physicians such as fellows and residents or nurse practitioners and physician assistants75,76,77 . These experienced but less senior providers may oversee another tier of extenders who have less critical care experience, such as physicians from other specialties or other advanced practice providers.…”

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confidence: 99%

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Mechanical-Ventilation Supply and Options for the COVID-19 Pandemic. Leveraging All Available Resources for a Limited Resource in a Crisis

Dar¹,

Swamy

Gavin

et al. 2021

Annals ATS

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The novel coronavirus disease (COVID-19) has exposed critical supply shortages both in the United States and worldwide, including those in intensive care unit (ICU) and hospital bed supply, hospital staff, and mechanical ventilators. Many of those who are critically ill have required days to weeks of supportive invasive mechanical ventilation (IMV) as part of their treatment. Previous estimates set the U.S. availability of mechanical ventilators at approximately 62,000 full-featured ventilators, with 98,000 non–full-featured devices (including noninvasive devices). Given the limited availability of this resource both in the United States and in low- and middle-income countries, we provide a framework to approach the shortage of IMV resources. Here we discuss evidence and possibilities to reduce overall IMV needs, discuss strategies to maximize the availability of IMV devices designed for invasive ventilation, discuss the underlying methods in the literature to create and fashion new sources of potential ventilation that are available to hospitals and front-line providers, and discuss the staffing needs necessary to support IMV efforts. The pandemic has already pushed cities like New York and Boston well beyond previous ICU capacity in its first wave. As hot spots continue to develop around the country and the globe, it is evident that issues may arise ahead regarding the efficient and equitable use of resources. This unique challenge may continue to stretch resources and require care beyond previously set capacities and boundaries. The approaches presented here provide a review of the known evidence and strategies for those at the front line who are facing this challenge.

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Section: Mechanical Ventilation Is More Than the Ventilatormentioning

confidence: 99%

mentioning

confidence: 99%

Mechanical-Ventilation Supply and Options for the COVID-19 Pandemic. Leveraging All Available Resources for a Limited Resource in a Crisis

Dar¹,

Swamy

Gavin

et al. 2021

Annals ATS

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“…Thereafter, multiple states experienced an increased number of COVID-19 cases; New York State became one of the epicenters of the disease spread (Center for Infectious Disease Research and Policy, 2020). On March 17, 2020, all fifty states across the United States had confirmed cases of COVID-19 (Abir et al, 2020). On March 26, 2020, the J o u r n a l P r e -p r o o f J o u r n a l P r e -p r o o f Gibson and Rush (2020), utilized GIS technology to outline dwelling boundaries to detect the probability of COVID-19 spread in Cape Town, South Africa.…”

Section: Introductionmentioning

confidence: 99%

GIS-based spatial modeling of COVID-19 incidence rate in the continental United States

Mollalo

Vahedi

Rivera

2020

Science of The Total Environment

608

584

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Journal Pre-proof J o u r n a l P r e -p r o o f 2 GIS-based Spatial Modeling of COVID-19 Incidence Rate in the Continental United States AbstractDuring the first 90 days of the COVID-19 outbreak in the United States, over 675,000 confirmed cases of the disease have been announced, posing unprecedented socioeconomic burden to the country. Due to inadequate research on geographic modeling of COVID-19, we investigated county-level variations of disease incidence across the continental United States. We compiled a geodatabase of 35 environmental, socioeconomic, topographic, and demographic variables that could explain the spatial variability of disease incidence. Further, we employed spatial lag and spatial error models to investigate spatial dependence and geographically weighted regression (GWR) and multiscale GWR (MGWR) models to locally examine spatial non-stationarity. The results suggested that even though incorporating spatial autocorrelation could significantly improve the performance of the global ordinary least square model; these models still represent a significantly poor performance compared to the local models. Moreover, MGWR could explain the highest variations (adj. R 2 : 68.1%) with the lowest AICc compared to the others. Mapping the effects of significant explanatory variables (i.e., income inequality, median household income, the proportion of black females, and the proportion of nurse practitioners) on spatial variability of COVID-19 incidence rates using MGWR could provide useful insights to policymakers for targeted interventions.

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“…Recent strategies and web tools to meet surge capacity for staffing: Recently, novel approaches to expeditiously increase the clinical workforce have been adopted to augment the large number of clinicians who are required to provide care during the COVID-19 surge and to replace acutely ill healthcare workers. [46][47][48] First, retirees of all medical professions have been invited to rejoin the workforce. Second, state-based licensing requirements have been relaxed to allow medical professionals to cross state lines.…”

Section: Figure 2 Tiered Staffing Strategy For Pandemicmentioning

confidence: 99%

“…52 Interconnectedness: It should be apparent that all hospital and ICU resources discussed in this report are interconnected and cannot work independently. 48 Each of the three domains-ICU beds, support equipment (including ventilators), and the critical care team-are essential components of patient management resources during a pandemic or other crisis that stresses a healthcare site or system. Simply adding more of one resource element without considering the interconnectedness of the healthcare system's many assets is unwise and potentially unsafe in planning for or managing patients during a pandemic such as COVID-19.…”

Section: Figure 2 Tiered Staffing Strategy For Pandemicmentioning

confidence: 99%

Supporting resilience

Brodrick¹,

O'Rourke²,

Angelo³

et al. 2020

Nursing Management

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With the onset of COVID-19 1 and the strong possibility of large percentages of the U.S. population being admitted to the hospital and intensive care unit (ICU), the Society of Critical Care Medicine (SCCM) has updated its statistics on critical care with this new document focusing resources available for COVID-19 in the United States. 2 Our goal is to provide information regarding the resources needed and available to care for a potentially overwhelming number of critically ill patients, many of whom may require mechanical ventilation. 1 In this report, we address the most current data and estimates on the number of acute care, ICU, and step-down (eg, observation, progressive) beds; ICU occupancy rates; mechanical ventilators; and staffing. We also seek to provide context to the data. Acute care hospitals; ICU, step-down, and burn beds: The American Hospital Association (AHA) maintains a proprietary dataset of most non-federal hospitals in the United States. Data is gathered by voluntary survey. In April 2019, a study published in Critical Care Medicine analyzed the 2015 AHA data. 3 For this current report, we extended the analysis from that publication using the most currently available 2018 AHA data while noting minimal changes from 2015. 4 The 2018 AHA data indicate that there are 5256 AHA-registered community hospitals in the United States. Of these, 2704 (51.4%) provide ICU services (Figure 3). These hospitals have 534,964 staffed (operational) acute care beds, including 96,596 ICU beds (Table 1), accounting for a median 16.7% of all hospital beds. The ICU beds are categorized as adult, pediatric, or neonatal.

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Critical Care Surge Response Strategies for the 2020 COVID-19 Outbreak in the United States

Cited by 44 publications

References 20 publications

Mechanical-Ventilation Supply and Options for the COVID-19 Pandemic. Leveraging All Available Resources for a Limited Resource in a Crisis

Mechanical-Ventilation Supply and Options for the COVID-19 Pandemic. Leveraging All Available Resources for a Limited Resource in a Crisis

GIS-based spatial modeling of COVID-19 incidence rate in the continental United States

Supporting resilience

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