1. From intensive care to step-down units: Managing patients throughput in response to COVID-19
- Author
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Agnoletti, Vanni, Russo, Emanuele, Circelli, Alessandro, Benni, Marco, Bolondi, Giuliano, Martino, Costanza, Domenico, P, Santonastas, O, Brogi, Etrusca, Praticò, Beniamino, Coccolini, Federico, Fugazzola, Paola, Ansaloni, Luca, Gamberini, Emiliano, Agnoletti V., Russo E., Circelli A., Benni M., Bolondi G., Martino C., Santonastaso D.P., Brogi E., Pratico B., Coccolini F., Fugazzola P., Ansaloni L., and Gamberini E.
- Subjects
Waiting time ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Critical Illness ,Coronaviru ,Intensivist ,intensive care unit ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,length of stay ,law ,Intensive care ,Epidemiology ,medicine ,Humans ,Mass Casualty Incidents ,AcademicSubjects/MED00860 ,030212 general & internal medicine ,mass casualty incident ,Personal protective equipment ,Pandemics ,Coronavirus ,Hospital Bed Capacity ,Intensive Care Units ,Length of Stay ,Step Down Units ,Bed Occupancy ,business.industry ,SARS-CoV-2 ,030503 health policy & services ,Health Policy ,Public Health, Environmental and Occupational Health ,COVID-19 ,General Medicine ,medicine.disease ,Intensive care unit ,hospital bed capacity ,Mass-casualty incident ,Italy ,Quality in Practice ,Medical emergency ,step-down units ,0305 other medical science ,business ,Intermediate Care Facilities - Abstract
Quality problem or issue The on-going COVID-19 pandemic may cause the collapse of healthcare systems because of unprecedented hospitalization rates. Initial assessment A total of 8.2 individuals per 1000 inhabitants have been diagnosed with COVID-19 in our province. The hospital predisposed 110 beds for COVID-19 patients: on the day of the local peak, 90% of them were occupied and intensive care unit (ICU) faced unprecedented admission rates, fearing system collapse. Choice of solution Instead of increasing the number of ICU beds, the creation of a step-down unit (SDU) close to the ICU was preferred: the aim was to safely improve the transfer of patients and to relieve ICU from the risk of overload. Implementation A nine-bed SDU was created next to the ICU, led by intensivists and ICU nurses, with adequate personal protective equipment, monitoring systems and ventilators for respiratory support when needed. A second six-bed SDU was also created. Evaluation Patients were clinically comparable to those of most reports from Western Countries now available in the literature. ICU never needed supernumerary beds, no patient died in the SDU, and there was no waiting time for ICU admission of critical patients. SDU has been affordable from human resources, safety and economic points of view. Lessons learned COVID-19 is like an enduring mass casualty incident. Solutions tailored on local epidemiology and available resources should be implemented to preserve the efficiency and adaptability of our institutions and provide the adequate sanitary response.
- Published
- 2021