ABSTRACT
Introduction: The North East London Critical Care Transfer And Retrieval (NECCTAR) service was developed in response to the COVID-19 pandemic to provide an additional resilience layer for intensive care provision. Emergent capability development of the service spanned equipping, training, and operating procedure design with an overarching robust governance and data infrastructure. An overwhelming need to help sustain critical care provision was such that scalability became a fundamental component of service design.1 Pressures varied, and so the trigger for deployment of a second team was data-driven based on sector critical care occupancy.2 This paper explores population-based thresholds for anticipating a surge in demand on critical care transfer services. Objectives: Identification of population-based indicators for generalizable thresholds for upscaling retrieval resources. Methods: The service was deployed as a sector-wide asset within a regional hub including clinical and administration staff. Daily sector-wide situational assessments were undertaken implementing a joint decision model. Occupancy, staffing, and specified risk data variables were prospectively collected along with tasking data. Transfer activity was then analysed alongside sector occupancy data to provide insight into current service provision and to rapidly and flexibly scale resources. Results: NECCTAR has been tasked 376 times and has completed 333 transfers (88.5%) in the 250 days between December 2020 and August 2021. On average, the transfer team completed 1.5 taskings per day with peaks and troughs. Tasking reasons included clinical retrieval (123, 32.7%), decompression (193, 51.3%), repatriation (59, 15.7%), and compassionate (1, 0.3%). 339 taskings (90.1%) originated within the North East London region, 27 (7.2%) from other London regions, and 7 (1.8%) from the rest of the nation. 208 patients (55.4%) had tested positive for COVID-19 during their admission, and 168 (44.6%) were COVID-19 negative. Demand for ICU related transfers varied with the waves of the pandemic and NECCTAR scaled to the needs of the sector. A second NECCTAR team was deployed available for a 47-day period from January 12th to Feb 28th 2021. During this period, NECCTAR was tasked 138 times, for an average of 2.9 transfers per day and 110 of these taskings (79.8%) were COVID-19 patients. Our modelling, data collection, and real-world observation, provided a threshold of 12 sector critical care patients per 100,000 population to trigger the deployment of a second NECCTAR team. The second team was maintained for an additional week after the rate fell below the threshold so that NECCTAR could assist with repatriations and closing of surge beds. Conclusion: During surge periods, NECCTAR was able to scale its service and match its capabilities to regional requirements and maintain the capability needed to undertake twice as many transfers per day. In periods of high COVID surge activity, greater volumes of COVID-19 decompression moves were undertaken and a second team was deployed to match the sector's needs. Extensive data collection and analysis has provided evidence for using a threshold of 12 critical care patients per 100,000 regional population for upscaling service provision, ensuring the allocation of resources is data-driven.