Hospital Preparedness for COVID-19: A Practical Guide from a Critical Care Perspective

Abstract

In response to the estimated potential impact of COVID-19 on New York City hospitals, our institution prepared for an influx of critically ill patients. Multiple areas of surge planning progressed simultaneously focused on infection control, clinical operational challenges, intensive care unit surge capacity, staffing, ethics and maintenance of staff wellness. Protocols developed focused on clinical decisions around intubation, the use of high-flow oxygen, infectious disease consultation and cardiac arrest. Mechanisms to increase bed capacity as well as increase efficiency in intensive care units by outsourcing procedures were implemented. Novel uses of technology to minimize staff exposure to COVID-19, as well as to facilitate family engagement and end of life discussions were encouraged. Education and communication remained key in attempting to standardize care, stay apprized on emerging data as well as to review seminal literature on respiratory failure. Challenges were encountered, and overcome through interdisciplinary collaboration and iterative surge planning as intensive care unit admissions rose. Support was provided for both clinical and nonclinical staff affected by the profound impact COVID-19 had on our city. We describe in granular detail, the procedures and processes developed during a one month period while surge planning was ongoing and the need for intensive care unit capacity rose exponentially. The approaches described provide a potential roadmap for centers that must rapidly adapt to the tremendous challenge introduced by this and potential future pandemics. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).