Mass Critical Care Surge Response During COVID-19: Implementation of Contingency Strategies - A Preliminary Report of Findings From the Task Force for Mass Critical Care.

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Citation: Chest. 161(2):429-447, 2022 02.PMID: 34499878Institution: MedStar Montgomery Medical CenterForm of publication: Journal ArticleMedline article type(s): Practice GuidelineSubject headings: *Advisory Committees | *COVID-19 | *Critical Care | *Delivery of Health Care/og [Organization & Administration] | *Surge Capacity | *Triage | COVID-19/ep [Epidemiology] | COVID-19/th [Therapy] | Critical Care/mt [Methods] | Critical Care/og [Organization & Administration] | Evidence-Based Practice/mt [Methods] | Evidence-Based Practice/og [Organization & Administration] | Humans | SARS-CoV-2 | Surge Capacity/og [Organization & Administration] | Surge Capacity/st [Standards] | Triage/mt [Methods] | Triage/st [Standards] | United States/ep [Epidemiology]Year: 2022ISSN:
  • 0012-3692
Name of journal: ChestAbstract: BACKGROUND: Following the publication of 2014 consensus statement regarding mass critical care during public health emergencies, much has been learned about surge responses and the care of overwhelming numbers of patients during the COVID-19 pandemic.1 Gaps in prior pandemic planning were identified and require modification in the midst of ongoing surge throughout the world.CONCLUSIONS: A subcommittee from the Task Force for Mass Critical Care offers interim evidence-informed operational strategies to assist hospitals and communities to plan for and respond to surge capacity demands from COVID-19. Copyright (c) 2021. Published by Elsevier Inc.METHODS: The Task Force for Mass Critical Care (TFMCC) adopted a modified version of established rapid guideline methodologies from the World Health Organization2 and the Guidelines International Network-McMaster Guideline Development Checklist.3 With a consensus development process incorporating expert opinion to define important questions and extract evidence, TFMCC developed relevant pandemic surge suggestions in a structured manner, incorporating peer-reviewed literature, "gray" evidence from lay media sources, and anecdotal experiential evidence.RESULTS: Ten suggestions were identified regarding staffing, load-balancing, communication, and technology. Staffing models are suggested with resilience strategies to support critical care staff. Intensive care unit (ICU) surge strategies and strain indicators are suggested to enhance ICU prioritization tactics to maintain contingency level care and avoid crisis triage, with early transfer strategies to further load-balance care. We suggest intensivists and hospitalists be engaged with the incident command structure to ensure two-way communication, situational awareness, and the use of technology to support critical care delivery and families of patients in intensive care units (ICUs).All authors: Baum KD, Bowden KR, Burry LD, Christian MD, Devereaux AV, Dichter JR, Downar J, Feldman HJ, Ghazipura M, Hamele MT, Henry KN, Hick JL, Hossain T, Huffines M, Martland AMO, Maves RC, Mukherjee V, Ornoff D, Persoff J, Sprung CL, Task Force for Mass Critical Care Writing Group, Tosh PK, Uppal AOriginally published: Chest. 2021 Sep 06Chest. 161(2):429-447, 2022 02.Fiscal year: FY2022Fiscal year of original publication: FY2022Digital Object Identifier: Date added to catalog: 2021-11-01
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Journal Article MedStar Authors Catalog Article 34499878 Available 34499878

BACKGROUND: Following the publication of 2014 consensus statement regarding mass critical care during public health emergencies, much has been learned about surge responses and the care of overwhelming numbers of patients during the COVID-19 pandemic.1 Gaps in prior pandemic planning were identified and require modification in the midst of ongoing surge throughout the world.

CONCLUSIONS: A subcommittee from the Task Force for Mass Critical Care offers interim evidence-informed operational strategies to assist hospitals and communities to plan for and respond to surge capacity demands from COVID-19. Copyright (c) 2021. Published by Elsevier Inc.

METHODS: The Task Force for Mass Critical Care (TFMCC) adopted a modified version of established rapid guideline methodologies from the World Health Organization2 and the Guidelines International Network-McMaster Guideline Development Checklist.3 With a consensus development process incorporating expert opinion to define important questions and extract evidence, TFMCC developed relevant pandemic surge suggestions in a structured manner, incorporating peer-reviewed literature, "gray" evidence from lay media sources, and anecdotal experiential evidence.

RESULTS: Ten suggestions were identified regarding staffing, load-balancing, communication, and technology. Staffing models are suggested with resilience strategies to support critical care staff. Intensive care unit (ICU) surge strategies and strain indicators are suggested to enhance ICU prioritization tactics to maintain contingency level care and avoid crisis triage, with early transfer strategies to further load-balance care. We suggest intensivists and hospitalists be engaged with the incident command structure to ensure two-way communication, situational awareness, and the use of technology to support critical care delivery and families of patients in intensive care units (ICUs).

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