Hospital Preparedness for COVID-19: A Practical Guide from a Critical Care Perspective
Hospital Preparedness for COVID-19: A Practical Guide from a Critical Care Perspective
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DOI：
10.1164/rccm.202004-1037cp
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发表时间：
2020-06-01
影响因子：
24.7
通讯作者：
Lief, Lindsay
中科院分区：
文献类型：
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作者：
Griffin, Kelly M.;Karas, Maria G.;Lief, Lindsay
为应对新型冠状病毒（COVID-19）对纽约市医院的估计潜在影响，我们的机构为重症患者的涌入做好了准备。激增计划的多个领域取得了进展，同时关注感染控制、临床操作挑战、ICU激增能力、人员配备、道德和维护工作人员健康。制定的方案侧重于有关插管、使用高流量氧气、与传染病顾问接触和心脏骤停的临床决策。实施了通过外包程序增加ICU床位容量和提高效率的机制。鼓励创新科技，以尽量减少员工接触COVID-19，并促进家庭参与和临终讨论。教育和沟通仍然是我们尝试标准化护理、了解新出现的数据和回顾有关呼吸衰竭的开创性文献的关键。随着ICU入院人数的增加，通过跨学科合作和迭代激增计划遇到并克服了挑战。我们为受COVID-19对我们城市的深远影响影响的临床和非临床工作人员提供支持。我们详细描述了在一个月的时间内制定的程序和流程，而激增计划正在进行中，对ICU容量的需求呈指数级增长。这里描述的方法为必须快速适应这一和未来潜在流行病带来的巨大挑战的中心提供了一个潜在的路线图。
In response to the estimated potential impact of coronavirus disease (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, ICU surge capacity, staffing, ethics, and maintenance of staff wellness. The protocols developed focused on clinical decisions regarding intubation, the use of high-flow oxygen, engagement with infectious disease consultants, and cardiac arrest. Mechanisms to increase bed capacity and increase efficiency in ICUs 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 our attempts to standardize care, stay apprised on emerging data, and review seminal literature on respiratory failure. Challenges were encountered and overcome through interdisciplinary collaboration and iterative surge planning as ICU 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 that were developed during a 1-month period while surge planning was ongoing and the need for ICU capacity rose exponentially. The approaches described here provide a potential roadmap for centers that must rapidly adapt to the tremendous challenge posed by this and potential future pandemics.