2020 Barsan Emergency Medicine Research Day

1. Christina Cutter MD MSc
MahshidAbir MD MSc
Critical Care Surge Response Strategies
Barsan Research Forum 2020
COVID-19

2. DISCLOSURES

3. OUTLINE
Background
The Problem
Our Response
Recommended Strategies
Capacity Building Tool
phil.cdc.gov

4. BACKGROUND
phil.cdc.gov

5. THE PROBLEM
Healthcare Capacity
CRITICAL CARE
50% ICU
50% Intensivist
94% Metropolitan
Pandemic Demand
ICU bed deficit: 295,350
>500%

6. OUR RESPONSE
Effective
Critical Care
Surge Response
SPACE STUFFSTAFF SYSTEMS
SURVEY ROUNDTABLES
#1
#2
DATASOURCES DELIVERABLES

7. STRATEGIES: SPACE
EXISTINGSPACE
“We think we can double
our ICU capacity by
working with our
endoscopy and other
procedural area spaces as
well as the PACU.”
BEYOND HOSPITALS
“My thought is that we try
and offload as much of
the floor-level medical
care, that’s what I think
we try to repurpose or
relocate.”
LEVERAGE TELEMEDICINE
“We really do need
community hospitals to
do critical care as well,
and that’s going tobe
challenging.”
ADDRESS OUTFLOW
“Build COVID SNFs [skilled
nursing facilities], COVID
sub-acute facilities so that
we fix the outflow
obstruction to help us
expand our capability.”

8. STRATEGIES: STAFF
TEAM-BASED STAFFING
“One medical resident and
one anesthesia resident sort
of combine their skill sets…”
EXTENDERS “I absolutely think so
[regarding critical care
physicians and supervising
noncritical care
physicians]. I think that’s
the way that it will be if we
have to double or triple
patient capacity.”
OTHERDEPARTMENTS
“Surgeons, internists, all sorts
of people are volunteering to
help out in some capacity. So I
think some of it will be us
giving them more direction and
them carrying it out.”
EXTERNAL RECRUITMENT
“Being very aggressive
and looking at all
options to enhance the
workforce and staffing.”

9. STRATEGIES: STUFF
REUSE PPE
“That’s challenging
because it’s a change in
culture and in
recommendations to
health care providers.”
DONATIONS
“We’ve also set up a
website to help
coordinate the
community donations
and other facility
donations.”
NOVEL SUPPLY CHAIN
“We’re looking at some novel
supply chain approaches. We’re
working with Home Depot right
now as a potential for getting
some N95 masks as well as
some direct lines from overseas.”
EQUIPMENT STRATEGIES
“The concept is to have several
patients with similar tidal volumes
and similar pressures that the
ventilator circuits are split and that
you’re ventilating multiple patients
with a single ventilator.”

10. STRATEGIES: SYSTEMS
REGIONALIZATION
“I think there needs to be a mandate…
for all health care facilities to have a
real-time automated capacity reporting
process through the states. So, we really
have a better feel for where there is
capacity within systems.”
ALLOCATION
“Every intensivist is
considered a triage officer
and then if the state
approves it, we will have
these triage committees that
will…decide who gets
removed from ventilators.”
RESOURCE AWARENESS
“So our guidance within the
hospital where we can control it
and have funds to outbid others is
very different because our
supplies are very differentrelative
to the public hospital systems.”
INTEGRATE INFORMATION
“The technology makes it much,
much easier and these APIs
[application programming
interface] can be created. It’s been
a permissions issue between
facilities. So that’s another lever
for federal government."

11. CAPACITY BUILDING TOOL

12. ACKNOWLEDGEMENTS
Innovate
Learn
Iterate
Share
Mahshid Abir
Christopher Nelson
Edward Chan
Hamad Al-Ibrahim
Karishma Patel
Andy Bogart
TEAM LESSONS GRATITUDE
#HailToTheFrontLine