Surge capacity and capability of intensive care units across a large healthcare system: An operational blueprint for regional integration

Authors

  • Abhijit Duggal, MD, MPH, MSc https://orcid.org/0000-0003-4220-2359
  • Erica Orsini, MD
  • Eduardo Mireles-Cabodevila, MD
  • Sudhir Krishnan, MD
  • Prabalini Rajendram, MD
  • Riley Carpenter, BA
  • Hassan Khouli, MD
  • Umur Hatipoglu, MD, MBA
  • Raed Dweik, MD, MBA

DOI:

https://doi.org/10.5055/ajdm.2021.0400

Keywords:

regionalization, surge capacity, pandemic, COVID-19, health system integration

Abstract

Objective: Many hospitals were unprepared for the surge of patients associated with the spread of coronavirus disease 2019 (COVID-19) pandemic. We describe the processes to develop and implement a surge plan framework for resource allocation, staffing, and standardized management in response to the COVID-19 pandemic across a large integrated regional healthcare system.

Setting: A large academic medical center in the Cleveland metropolitan area, with a network of 10 regional hospitals throughout Northeastern Ohio with a daily capacity of more than 500 intensive care unit (ICU) beds.

Results: At the beginning of the pandemic, an equitable delivery of healthcare services across the healthcare system was developed. This distribution of resources was implemented with the potential needs and resources of the individual ICUs in mind, and epidemiologic predictions of virus transmissibility. We describe the processes to develop and implement a surge plan framework for resource allocation, staffing, and standardized management in response to the COVID-19 pandemic across a large integrated regional healthcare system. We also describe an additional level of surge capacity, which is available to well-integrated institutions called “extension of capacity.” This refers to the ability to immediately have access to the beds and resources within a hospital system with minimal administrative burden.

Conclusions: Large integrated hospital systems may have an advantage over individual hospitals because they can shift supplies among regional partners, which may lead to faster mobilization of resources, rather than depending on local and national governments. The pandemic response of our healthcare system highlights these benefits.

Author Biographies

Abhijit Duggal, MD, MPH, MSc

Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland Clinic Lerner School of Medicine of Case Western Reserve University, Cleveland, Ohio

Erica Orsini, MD

Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland Clinic Lerner School of Medicine of Case Western Reserve University, Cleveland, Ohio

Eduardo Mireles-Cabodevila, MD

Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland Clinic Lerner School of Medicine of Case Western Reserve University, Cleveland, Ohio

Sudhir Krishnan, MD

Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland Clinic Lerner School of Medicine of Case Western Reserve University, Cleveland, Ohio

Prabalini Rajendram, MD

Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland Clinic Lerner School of Medicine of Case Western Reserve University, Cleveland, Ohio

Riley Carpenter, BA

Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland Clinic Lerner School of Medicine of Case Western Reserve University, Cleveland, Ohio

Hassan Khouli, MD

Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland Clinic Lerner School of Medicine of Case Western Reserve University, Cleveland, Ohio

Umur Hatipoglu, MD, MBA

Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland Clinic Lerner School of Medicine of Case Western Reserve University, Cleveland, Ohio

Raed Dweik, MD, MBA

Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland Clinic Lerner School of Medicine of Case Western Reserve University, Cleveland, Ohio

References

Inside a Brooklyn hospital that is overwhelmed with COVID-19 patients and deaths. CNN. Available at https://www.cnn.com/2020/03/30/us/brooklyn-hospital-coronavirus-patients-deaths/index.html. Accessed July 31, 2020.

Coronavirus: Italy’s hardest-hit city wants you to see how COVID- 19 is affecting its hospitals | World News. Sky News. Available at https://news.sky.com/story/coronavirus-they-call-it-the-apocalypseinside-italys-hardest-hit-hospital-11960597. Accessed August 30, 2020.

US crosses 10 million COVID-19 cases as third wave of infections surges. Reuters. Available at https://www.reuters.com/article/us-health-coronavirus-usa-records/u-s-crosses-10-million-covid-19-cases-as-third-wave-of-infections-surges-idUSKBN27P00U. Accessed December 22, 2020.

Ma X, Vervoort D: Critical care capacity during the COVID-19 pandemic: Global availability of intensive care beds. J Crit Care. 2020; 58: 96-97. DOI: 10.1016/j.jcrc.2020.04.012.

Hodge JG, Brown EF: Assessing liability for health care entities that insufficiently prepare for catastrophic emergencies. J Am Med Assoc. 2011; 306(3): 308-309. DOI: 10.1001/jama.2011.996.

Preparing your ICU for disaster response. Available at https://store.sccm.org/detail.aspx?id=EPREPARE. Accessed December 27, 2020.

Institute of Medicine: Crisis Standards of Care. Washington, DC: National Academies Press, 2012. DOI: 10.17226/13351.

Hick JL, Einav S, Hanfling D, et al.: Surge capacity principles: Care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest. 2014; 146(4): e1S-e16S. DOI: 10.1378/chest.14-0733.

As hospitals strain under influx of COVID-19 patients, deaths are climbing: Shots-health news. NPR. Available at https://www.npr.org/sections/health-shots/2020/11/25/939103515/near-crisis-some-hospitals-face-tough-decisions-in-caring-for-floods-of-patients. Accessed December 27, 2020.

Karaca-Mandic P, Sen S, Georgiou A, et al.: Association of COVID-19-related hospital use and overall COVID-19 mortality in the USA. J Gen Intern Med. 2020; DOI: 10.1007/s11606-020-06084-7.

Hick JL, Barbera JA, Kelen GD: Refining surge capacity: Conventional, contingency, and crisis capacity. Disaster Med Public Health Prep. 2009; 3(Suppl. 1): S59-S67. DOI: 10.1097/DMP.0b013e31819f1ae2.

Einav S, Hick JL, Hanfling D, et al.: Surge capacity logistics: Care of the critically ill and injured during pandemics and disasters: Chest consensus statement. Chest. 2014; 146(4): e17S-e43S. DOI: 10.1378/chest.14-0734.

Hick JL, Christian MD, Sprung CL: Chapter 2. Surge capacity and infrastructure considerations for mass critical care. Intensive Care Med. 2010; 36(Suppl. 1): 11-20. DOI: 10.1007/s00134-010-1761-4.

Fulton BD: Health care market concentration trends in the United States: Evidence and policy responses. Health Affairs. 2017; 36(9): 1530-1538. DOI: 10.1377/hlthaff.2017.0556.

Why surviving covid might come down to which NYC hospital admits you. The New York Times. Available at https://www.nytimes.com/2020/07/01/nyregion/Coronavirus-hospitals.html. Accessed August 10, 2020.

Stoller JK: The Cleveland Clinic: A distinctive model of American Medicine. Ann Transl Med. 2014; 2(4): 33. DOI: 10.3978/j.issn.2305-5839.2013.12.02.

Mihaljevic T: Tiered daily huddles: The power of teamwork in managing large healthcare organisations. BMJ Qual Saf. 2020; 29(12): 1050-1052. DOI: 10.1136/bmjqs-2019-010575.

Tiered huddles improve quality across the system – consult QD. Available at https://consultqd.clevelandclinic.org/tiered-huddlesimprove-quality-across-the-system/. Accessed December 22, 2020.

Cleveland Clinic Healthcare Education: Available at https://healthcareedu.ccf.org/. Accessed December 22, 2020.

Hick JL, Hanfling D, Burstein JL, et al.: Health care facility and community strategies for patient care surge capacity. Ann Emerg Med. 2004; 44(3): 253-261. DOI: 10.1016/j.annemergmed.2004.04.011.

Soremekun OA, Zane RD, Walls A, et al.: Cancellation of scheduled procedures as a mechanism to generate hospital bed surge capacity—A pilot study. Prehosp Disaster Med. 2011; 26(3): 224-229. DOI: 10.1017/S1049023X11006248.

Bissell RA, Pinet L, Nelson M, et al.: Evidence of the effectiveness of health sector preparedness in disaster response: The example of four earthquakes. Family Commun Health. 2004; 27(3): 193-203. DOI: 10.1097/00003727-200407000-00006.

How we created a hospital for COVID-19 patients in less than a month. Consult QD. Available at https://consultqd.clevelandclinic.org/how-we-created-a-hospital-for-covid-19-patients-in-less-than-amonth/. Accessed August 1, 2020.

Halpern NA and Tan KS: US ICU Resource Availability for COVID-19. Mount Prospect, IL: Society of Critical Care Medicine. 2020. Available at https://sccm.org/Blog/March-2020/United-States-Resource-Availability-for-COVID-19?_zs=OdHjd1&_zl=w9pb6. Accessed September 8, 2021.

Orsini E, Mireles-Cabodevila E, Ashton R, et al.: Lessons on outbreak preparedness from the Cleveland Clinic. Chest. 2020; 158(5): 2090-2096. DOI: 10.1016/j.chest.2020.06.009.

Wells CR, Fitzpatrick MC, Sah P, et al.: Projecting the demand for ventilators at the peak of the COVID-19 outbreak in the USA. Lancet Infect Dis. 2020; 20: 1123-1120. DOI: 10.1016/S1473-3099(20)30315-7.

Chatburn RL, Branson RD, Hatipog˘lu U: Multiplex ventilation: A simulation-based study of ventilating 2 patients with a single ventilator. Respir Care. 2020; 65(7): 920-931. DOI: 10.4187/respcare.07882.

Neyman G, Irvin CB: A single ventilator for multiple simulated patients to meet disaster surge. Acad Emerg Med. 2006; 13(11): 1246-1249. DOI: 10.1197/j.aem.2006.05.009.

Dosch M: Using the anesthesia workstation as a ventilator for critically ill patients: Technical considerations. Available at www.aana.com/aanajournalonline. Accessed November 2, 2020.

Hatipog˘lu U: Can multiple ARDS patients be ventilated with a single ventilator? Cleveland Clin J Med. 2020; 87(5): 259-261. DOI: 10.3949/ccjm.87a.20043.

Cheung VK-L, So EH-K, Ng GW-Y, et al.: Investigating effects of healthcare simulation on personal strengths and organizational impacts for healthcare workers during COVID-19 pandemic: A cross-sectional study. Integr Med Res. 2020; 9(3): 100476. DOI: 10.1016/j.imr.2020.100476.

Situation Report-86 Highlights: Available at https://www.who.int/teams/risk-communication/infodemic-management. Accessed December 27, 2020.

Published

09/01/2021

How to Cite

Duggal, MD, MPH, MSc, A., E. Orsini, MD, E. Mireles-Cabodevila, MD, S. Krishnan, MD, P. Rajendram, MD, R. Carpenter, BA, H. Khouli, MD, U. Hatipoglu, MD, MBA, and R. Dweik, MD, MBA. “Surge Capacity and Capability of Intensive Care Units across a Large Healthcare System: An Operational Blueprint for Regional Integration”. American Journal of Disaster Medicine, vol. 16, no. 3, Sept. 2021, pp. 179-92, doi:10.5055/ajdm.2021.0400.

Issue

Section

Articles