Assembly Line ICU: what the Long Shops taught us about managing surge capacity for COVID-19. Issue 4 (4th December 2020)

• Record Type: Journal Article
• Authors: Oakley, Callum; Pascoe, Craig; Balthazor, Daivd; Bennett, Davinia; Gautam, Nandan; Isaac, John; Isherwood, Peter; Matthews, Tracie; Murphy, Nick; Oelofse, Tessa; Patel, Jaimin; Snelson, Catherine; Richardson, Carla; Willson, Jeremy; Wyton, Fiona; Veenith, Tonny; Whitehouse, Tony
• Other Names: author non-byline.; Ford Abby author non-byline.; Barrios Alejandro author non-byline.; Johnston Andy author non-byline.; Shah Anwar author non-byline.; Tunnicliffe Bill author non-byline.; Bion Julian author non-byline.; Pouchet Brian author non-byline.; Hume David author non-byline.; Riddington David author non-byline.; Turfrey Deborah author non-byline.; Parekh Dhruv author non-byline.; Packer Gregory author non-byline.; Singh Harjot author non-byline.; Ewington Ian author non-byline.; Kelly John author non-byline.; England Kaye author non-byline.; Tasker Laura author non-byline.; Bangash Mansoor author non-byline.; Manji Mav author non-byline.; Knowles Mike author non-byline.; Arshad Mohammed author non-byline.; Abeysinghe Neil author non-byline.; Talbot Nicholas author non-byline.; Parekh Nilesh author non-byline.; El-Dalil Phillip author non-byline.; Mullhi Randeep author non-byline.; Chauhan Ravi author non-byline.; Hebballi Ravi author non-byline.; Browne Richard author non-byline.; Denham Sam author non-byline.; Walia Sandeep author non-byline.; Goyal Shraddha author non-byline.; Kroll Steffen author non-byline.; Sinclair Sue author non-byline.; Clutton-Brock Tom author non-byline.; Torlinski Tomasz author non-byline.; Tosh William author non-byline.; Khan Zahid author non-byline.;
• Is Part Of: BMJ open quality. Volume 9:Issue 4(2020)
• Publication Date: 2020-12-04
• Subjects: critical care -- crisis management -- hospital medicine; Medical care -- Quality control -- Periodicals; 362.106805
• DOI: 10.1136/bmjoq-2020-001117
• Languages: English
• ISSNs: 2399-6641

Abstract

Abstract : Objectives: To safely expand and adapt the normal workings of a large critical care unit in response to the COVID-19 pandemic. Methods: In April 2020, UK health systems were challenged to expand critical care capacity rapidly during the first wave of the COVID-19 pandemic so that they could accommodate patients with respiratory and multiple organ failure. Here, we describe the preparation and adaptive responses of a large critical care unit to the oncoming burden of disease. Our changes were similar to the revolution in manufacturing brought about by 'Long Shops' of 1853 when Richard Garrett and Sons of Leiston started mass manufacture of traction engines. This innovation broke the whole process into smaller parts and increased productivity. When applied to COVID-19 preparations, an assembly line approach had the advantage that our ICU became easily scalable to manage an influx of additional staff as well as the increase in admissions. Healthcare professionals could be replaced in case of absence and training focused on a smaller number of tasks. Results: Compared with the equivalent period in 2019, the ICU provided 30.9% more patient days (2599 to 3402), 1845 of which were ventilated days (compared with 694 in 2019, 165.8% increase) while time from first referral to ICU admission reduced from 193.8±123.8 min (±SD) to 110.7±76.75 min (±SD). Throughout, ICU maintained adequate capacity and also accepted patients from neighbouring hospitals. This was done by managing an additional 205 doctors (70% increase), 168 nurses who had previously worked in ICU and another 261 nurses deployed from other parts of the hospital (82% increase). Our large tertiary hospital ensured a dedicated non-COVID ICU was staffed and equipped to take regional emergency referrals so that those patients requiring specialist surgery and treatment were treated throughout the COVID-19 pandemic. Conclusions: We report how the challenge of managing a huge influx of patients and redeployed staff was met by deconstructing ICU care into its constituent parts. Although reported from the largest colocated ICU in the UK, we believe that this offers solutions to ICUs of all sizes and may provide a generalisable model for critical care pandemic surge planning.