Thinking Ahead to Expand Intensive Care Unit Capacity for COVID-19 Pandemic

Preparation and collaboration has been crucial in the required restructuring of the intensive care unit (ICU) at Sierra View Medical Center (SVMC) to continue providing care during the ever-changing COVID-19 pandemic. Quickly developing methods to manage admitted COVID-19 patients in a designated COVID-19-specific ICU and devising a process to eliminate the potential of infecting a non-positive ICU patient was essential.

Critical care leadership led interdisciplinary team efforts that included the ICU team and several others to ensure SVMC’s ICU was prepared to expertly respond to COVID-19 related needs for the hospital’s patients.

“We had to create a plan that included a framework to expand staffing schedules, utilize detailed protocols for infection prevention, and work closely with our highly skilled intensivists. This included an around the clock clinical response to quickly deteriorating patients, accessing research trials for patients with COVID-19, ensuring adequate personal protection equipment (PPE) supplies and training, prioritizing diagnostic lab testing and forecasting demand,” said Dr. Kris Reddell, Director of Critical Care Services.

One of the ICU’s first tasks upon creating a high level plan was to manage an anticipated surge of COVID-19 patients while ensuring there was an adequate staffing model. “Based on results from other countries and from our own model, it necessitated operational maneuvers to increase the intensive care unit capacity for more patients with higher acuity needs such as specialized mechanical ventilation and special isolation requirements,” Dr. Kris Reddell said.

SVMC created two separate ICU units to manage the care of COVID-19 and non-COVID-19 patients. This step was taken to prevent cross contamination from one area to the other. The primary or existing ICU became the Alpha ICU and managed all COVID-19 critically ill patients. A secondary, geographically distant ICU named Beta ICU was created to continue caring for non-COVID-19 patients. Operating with geographically separate ICU’s has allowed SVMC to physically distance equipment and staff, while ensuring more effective containment. In addition, special equipment called high-efficiency particulate air (HEPA) filtered forced air machines are being used to generate a negative pressure environment in all positive COVID-19 patient rooms to maximize strict infection control measures.

“This process expanded our Current ICU patient abilities from 10 to 18 patients over the course of one day. Plans were in place working with another department to expand to 8 more ICU beds if necessary for positive COVID-19 patients, for total of 26 ICU beds.” 

Other measures including repurposing of equipment such as bed types, operating room ventilators, and portable patient monitoring devices have also been important aspects in adequately preparing to care for a possible surge in patients in a safe and quality manner.

As a result of the restructure of the ICU and quick response to adapting to rapidly changing protocols and guidelines, SVMC has been able to continue to provide high quality clinical management for the community’s healthcare needs. Additionally, SVMC has created a sustainable workforce which has been successful in implementing multiple changes in isolation protocols, infection control needs, and the increasing need for additional supplies, effective communication, and additional space.