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The Mount Sinai Hospital Institute for critical care medicine response to the COVID-19 pandemic

机译：西奈山医院的批判性医学研究所对Covid-19大流行的反应

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Background:The coronavirus disease 2019 (COVID-19) pandemic has resulted in a dramatic surge in the number of critically ill patients. This was especially true in New York city, the epicenter of the pandemic in the United States. In the present study, a roadmap was proposed for hospitals and health systems to prepare for a surge in critical care capacity.Methods:This was a retrospective review of how Mount Sinai Hospital (MSH) was able to rapidly prepare to handle the COVID-19 pandemic. How MSH, the largest academic hospital within the Mount Sinai Health System, rapidly expanded the intensive care unit (ICU) bed capacity, including creating new ICU beds in traditionally non-critical care areas, expanded the workforce for ICUs, and created guidelines to streamline workflow, is described in this review.Results:MSH expanded from a 1,139-bed quaternary care academic referral hospital with 104 ICU beds to 1,453 beds (27.5% increase) with 235 ICU beds (126% increase) during the pandemic peak in the first week of April 2020. From March to June 2020, with follow-up through October 2020, MSH admitted 2,591 COVID-19-positive patients, 614 to ICUs. Most admitted patients received noninvasive support including a non-rebreather mask, high flow nasal cannula, and noninvasive positive pressure ventilation. Among ICU patients, 68.4% (n=420) received mechanical ventilation; among the admitted ICU patients, 40.7% (n=250) died, and 47.8% (n=294) were discharged alive. Among the patients requiring mechanical ventilation, 55.0% (n=231) died and 43.1% (n=181) were discharged alive from the hospital.Conclusion:: Flexible bed management initiatives; teamwork across multiple disciplines; and development and implementation of guidelines for airway management, cardiac arrest, anticoagulation, vascular access, and proning were critical in streamlining workflow and accommodating the surge in critically ill patients. Non-ICU services and staff were deployed to augment the critical care work force and open new critical care units by leveraging a tiered staffing model. This approach to rapidly expand bed availability and staffing across the system helped provide the best care for the patients and saved lives.
机译：背景：2019年冠状病毒疾病（Covid-19）大流行导致了患者危重病患者的数量剧烈激增。这在纽约市尤其如此，美国大流行的震中。在本研究中，为医院和卫生系统提出了一条路线图，以准备在关键护理能力上的激增。方法：这是对山庄医院（MSH）如何快速准备处理Covid-19的回顾审查大流行病。 Most Mount Mobion System中最大的学术医院MSH如何迅速扩大重症监护室（ICU）床容量，包括在传统的非关键护理地区创建新的ICU床，扩大了ICU的劳动力，并创建了简化指导方针工作流程，在此评论中介绍。结果：MSH从139张床第四纪护理学术转诊医院扩展，104张ICU床上，在第一次大流行高峰期间，235张ICU床（增加27.5％）（增加126％） 2012年4月的一周。从3月到2020年6月，在2020年10月到来，MSH录取了2,591名Covid-19阳性患者，614名ICU。大多数录取的患者接受了非侵入性支持，包括非呼吸罩，高流量鼻腔插管和非侵入性正压通风。在ICU患者中，68.4％（n = 420）接受机械通气;在录取的ICU患者中，死亡40.7％（n = 250），还有47.8％（n = 294）。在需要机械通气的患者中，55.0％（n = 231）死亡，43.1％（n = 181）从医院中排出。结论::柔性床管理举措;跨越多学科的团队合作;和开发和实施航空管理，心脏骤停，抗凝，血管进入和拳击指南对简化工作流程并适应危重病患者的激增至关重要。部署非ICU服务和工作人员通过利用分层的人员配置模型来增加关键护理职责并开放新的关键保健单位。这种方法可以迅速扩大床可用性和跨系统的人员配备帮助为患者提供了最佳照顾和挽救的生命。

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