Preparing ICUs for pandemics

Innovation Amid Pandemic: Construction of a COVID-19 Intensive Care Unit Surge Care Delivery Model

This article details a shared leadership structure and decision-making processes used to construct an innovative and evidence-based care delivery model for safety and optimal outcomes in the intensive care unit during the novel coronavirus (COVID-19) pandemic. Insights into ways professional development practitioners can facilitate changes in care delivery models, support nurses in their professional roles, and contribute to improved patient care outcomes during the COVID-19 pandemic are provided.

Readiness of Medical Teams Caring for COVID-19 in the Intensive Care Units: A National Web-Based Survey in Indonesia

BACKGROUND: The coronavirus disease 2019 (COVID)-19 pandemic is a challenge for the intensive care unit (ICU) medical team. It requires management of space, stuff (medical equipment including drugs), staff, and system readiness (4S) to deal with the surge in the number of patients. AIM: This survey aims to describe the current readiness efforts among ICU medical team at the COVID-19 referral hospitals in Indonesia; space, stuff readiness, staff, and systems readiness. METHODS: We conducted a cross-sectional national web-based survey of ICUs across referral hospitals during pandemic COVID-19 in Indonesia from June to October 2020. The medical teams survey included 53 questions in multiple parts addressing five dimensions. A linear regression model was applied to determine the factors related with readiness. RESULTS: A total of 459 participants (83.6%) agreed to join in this study. The participants’ average age was 40.43 years (SD = 5.78). About 62.53% were male, 51.20% had bachelor degree, and 55.77% lived outside of Java Island. The mean of total score of medical team readiness was 2.76 (SD = 0.320) and the highest (maximum score) mean score of medical team readiness domain was stuff (2.81, SD = 7.72). Education, working experience, training, perception of risk of contracting COVID-19, and residence had a substantial effect on the readiness, with R2 values of 0.378, p < 0.05. CONCLUSIONS: This study provides an initial view of current preparedness efforts among a group of ICUs in Indonesia’s leading hospital during the first wave of pandemic. Interventions must be developed and implemented quickly to increase the medical team’s readiness to care for a future pandemic.

Spiritual care in critically ill patients during COVID-19 pandemic

Introduction

Spiritual care has a positive influence when patients are subjected to serious illnesses, and critically ill situations such as the case of the COVID-19 pandemic.

Purpose

The purpose of this study was to investigate the perceptions and attitudes of nurses working at critical care units and emergency services in Spain concerning the spiritual care providing to patients and families during the COVID-19 pandemic.

Methods

A qualitative investigation was carried out using in-depth interviews with 19 ICU nursing professionals.

Findings

During the pandemic, nurses provided spiritual care for their patients. Although they believed that spirituality was important to help patients to cope with the disease, they do not had a consensual definition of spirituality. Work overload, insufficient time and lack of training were perceived as barriers for providing spiritual healthcare.

Discussion

These results support the role of spirituality in moments of crisis and should be considered by health professionals working in critical care settings.

A critical care pandemic staffing framework in Australia

Background

Pandemics and the large-scale outbreak of infectious disease can significantly impact morbidity and mortality worldwide. The impact on intensive care resources can be significant and often require modification of service delivery, a key element which includes rapid expansion of the critical care workforce. Pandemics are also unpredictable, which necessitates rapid decision-making and action which, in the lack of experience and guidance, may be extremely challenging. Recognising the potential strain on intensive care units (ICUs), particularly on staffing, a working group was formed for the purpose of developing recommendations to support decision-making during rapid service expansion.

Methods

The Critical Care Pandemic Staffing Working Party (n = 21), representing nursing, allied health, and medical disciplines, has used a modified consensus approach to provide recommendations to inform multidisciplinary workforce capacity expansion planning in critical care.

Results

A total of 60 recommendations have been proposed which reflect general recommendations as well as those specific to maintaining the critical care workforce, expanding the critical care workforce, rostering and allocation of the critical care workforce, nurse-specific recommendations for staffing the ICU, education support and training during ICU surge situations, workforce support, models of care, and de-escalation.

Conclusion

These recommendations are provided with the intent that they be used to guide interdisciplinary decision-making, and we suggest that careful consideration is given to the local context to determine which recommendations are most appropriate to implement and how they are prioritised. Ongoing evaluation of recommendation implementation and impact will be necessary, particularly in rapidly changing clinical contexts.

Talking to the people that really matter about their participation in pandemic clinical research: A qualitative study in four European countries

Background

Pandemics of new and emerging infectious diseases are unpredictable, recurrent events that rapidly threaten global health and security. We aimed to identify public views regarding provision of information and consent to participate in primary and critical care clinical research during a future influenza‐like illness pandemic.

Methods

Descriptive‐interpretive qualitative study, using focus groups (n = 10) and semi‐structured interviews (n = 16), with 80 members of the public (>18 years) in Belgium, Spain, Poland and the UK. Local qualitative researchers followed a scenario‐based topic guide to collect data. Data were transcribed verbatim, translated into English and subject to framework analysis.

Results

Public understandings of pandemics were shaped by personal factors (illness during the previous H1N1 pandemic, experience of life‐threatening illness) and social factors (historical references, media, public health information). Informants appreciated safeguards provided by ethically robust research procedures, but current enrolment procedures were seen as a barrier. They proposed simplified enrolment processes for higher risk research and consent waiver for certain types of low‐risk research. Decision making about research participation was influenced by contextual, research and personal factors. Informants generally either carefully weighed up various approaches to research participation or responded instinctively. They supported the principle of using routinely collected, anonymized clinical biological samples for research without explicit consent, but regarded this as less acceptable if researchers were motivated primarily by commercial gain.

Conclusions

This bottom‐up approach to ascertaining public views on pandemic clinical research has identified support for more proportionate research protection procedures for publically funded, low‐risk studies.

Development of an Evacuation Tool to Facilitate Disaster Preparedness: Use in a Planned Evacuation to Support a Hospital Move

OBJECTIVES

Our institution relocated to a new facility 3.5 miles from our original location in Chicago on June 9, 2012. We describe the tools we developed to prepare, execute, and manage our evacuation and relocation.

METHODS

Tools developed for the planned evacuation included the following: level of acuity and team composition classification, patient departure checklist, evacuation handoff tool, and a patient tracking system within the electronic health record. Incident Command structure was utilized.

RESULTS

Monthly census tracking exercises were held beginning 12 months before the evacuation. Simulation drills began 6 months before the evacuation. The entire evacuation took less than 14 hours and there were no safety issues. A total of 127 patients were transported to the new facility: 45 patients were moved via the Neonatal/Pediatric Critical Care Transport Team, and the rest were moved with various team configurations.

CONCLUSION

Documents developed for a planned evacuation can be used for any planned or unplanned evacuation. We believe the tools we used to prepare, execute, and manage our evacuation and relocation would assist any health care facility to be better prepared to safely and efficiently evacuate patients in the event of a disaster, or to create surge capacity, and relocate them to another facility. (Disaster Med Public Health Preparedness. 2017;11:479-486).

Key stakeholder perceptions about consent to participate in acute illness research: a rapid, systematic review to inform epi/pandemic research preparedness

Background

A rigorous research response is required to inform clinical and public health decision-making during an epi/pandemic. However, the ethical conduct of such research, which often involves critically ill patients, may be complicated by the diminished capacity to consent and an imperative to initiate trial therapies within short time frames. Alternative approaches to taking prospective informed consent may therefore be used. We aimed to rapidly review evidence on key stakeholder (patients, their proxy decision-makers, clinicians and regulators) views concerning the acceptability of various approaches for obtaining consent relevant to pandemic-related acute illness research.

Methods

We conducted a rapid evidence review, using the Internet, database and hand-searching for English language empirical publications from 1996 to 2014 on stakeholder opinions of consent models (prospective informed, third-party, deferred, or waived) used in acute illness research. We excluded research on consent to treatment, screening, or other such procedures, non-emergency research and secondary studies. Papers were categorised, and data summarised using narrative synthesis.

Results

We screened 689 citations, reviewed 104 full-text articles and included 52. Just one paper related specifically to pandemic research. In other emergency research contexts potential research participants, clinicians and research staff found third-party, deferred, and waived consent to be acceptable as a means to feasibly conduct such research. Acceptability to potential participants was motivated by altruism, trust in the medical community, and perceived value in medical research and decreased as the perceived risks associated with participation increased. Discrepancies were observed in the acceptability of the concept and application or experience of alternative consent models. Patients accepted clinicians acting as proxy-decision makers, with preference for two decision makers as invasiveness of interventions increased. Research regulators were more cautious when approving studies conducted with alternative consent models; however, their views were generally under-represented.

Conclusions

Third-party, deferred, and waived consent models are broadly acceptable to potential participants, clinicians and/or researchers for emergency research. Further consultation with key stakeholders, particularly with regulators, and studies focused specifically on epi/pandemic research, are required. We highlight gaps and recommendations to inform set-up and protocol development for pandemic research and institutional review board processes.

PROSPERO protocol registration number

CRD42014014000

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-015-1110-6) contains supplementary material, which is available to authorized users.

Epidemiological features of influenza in Canadian adult intensive care unit patients

To identify predictive factors and mortality of patients with influenza admitted to intensive care units (ICU) we carried out a prospective cohort study of patients hospitalized with laboratory-confirmed influenza in adult ICUs in a network of Canadian hospitals between 2006 and 2012. There were 626 influenza-positive patients admitted to ICUs over the six influenza seasons, representing 17·9% of hospitalized influenza patients, 3·1/10,000 hospital admissions. Variability occurred in admission rate and proportion of hospital influenza patients who were admitted to ICUs (proportion range by year: 11·7-29·4%; 21·3% in the 2009-2010 pandemic). In logistic regression models ICU patients were younger during the pandemic and post-pandemic period, and more likely to be obese than hospital non-ICU patients. Influenza B accounted for 14·2% of all ICU cases and had a similar ICU admission rate as influenza A. Influenza-related mortality was 17·8% in ICU patients compared to 2·0% in non-ICU patients.

Ebola preparedness: a rapid needs assessment of critical care in a tertiary hospital

BACKGROUND

The current outbreak of Ebola has been declared a public health emergency of international concern. We performed a rigorous and rapid needs assessment to identify the desired results, the gaps in current practice, and the barriers and facilitators to the development of solutions in the provision of critical care to patients with suspected or confirmed Ebola.

METHODS

We conducted a qualitative study with an emergent design at a tertiary hospital in Ontario, Canada, recently designated as an Ebola centre, from Oct. 21 to Nov. 7, 2014. Participants included physicians, nurses, respiratory therapists, and staff from infection control, housekeeping, waste management, administration, facilities, and occupational health and safety. Data collection included document analysis, focus groups, interviews and walk-throughs of critical care areas with key stakeholders.

RESULTS

Fifteen themes and 73 desired results were identified, of which 55 had gaps. During the study period, solutions were implemented to fully address 8 gaps and partially address 18 gaps. Themes identified included the following: screening; response team activation; personal protective equipment; postexposure to virus; patient placement, room setup, logging and signage; intrahospital patient movement; interhospital patient movement; critical care management; Ebola-specific diagnosis and treatment; critical care staffing; visitation and contacts; waste management, environmental cleaning and management of linens; postmortem; conflict resolution; and communication.

INTERPRETATION

This investigation identified widespread gaps across numerous themes; as such, we have been able to develop a set of credible and measureable results. All hospitals need to be prepared for contact with a patient with Ebola, and the preparedness plan will need to vary based on local context, resources and site designation.