ABSTRACT
INTRODUCTION: The COVID-19 pandemic mandated rapid, flexible solutions to meet the anticipated surge in both patient acuity and volume. This paper describes one institution's Emergency Department innovation at the center of the COVID crisis, including the creation of a temporary ED-ICU and development of interdisciplinary COVID-specific care delivery models to care for critically ill patients. METHODS: Mount Sinai Hospital, an urban quaternary academic medical center, had an existing five-bed resuscitation area insufficiently resourced due to its size and lack of negative pressure (NP) rooms. The ED-based Observation Unit, which has four NP rooms, was deemed to be the ideal spot for a new ED-ICU. An interdisciplinary and intradepartmental task force was critical to this development. This task force worked to ensure the physical supplies, medications, staffing, and clinical protocols were appropriate to allow for the proper functioning of the ED-ICU. RESULTS: Within one week, the ED-based Observation Unit was quickly converted into a COVID-specific unit, split between a 14-bed stepdown unit and a 13-bed ED-ICU unit. The ED-ICU had all the functional and staffing capacities of an ICU, and was able to efficiently care for large numbers of critically ill patients. All critically ill patients in the ED were treated in the ED-ICU. Further, all intubations and non-invasive ventilation were able to occur in the negative pressure rooms. CONCLUSIONS: The Mount Sinai Hospital Emergency Department rapidly adapted the delivery of care and treatment models to meet the challenges of the COVID-19 pandemic. An ED-ICU was rapidly built by converting the prior observation area (a 27-bed zone). A redesign of a new space in a large U.S. academic hospital often requires months, if not years, of planning and negotiations with the varying hospital interests involved. With the pressure of high COVID demand, this conversion was executed in approximately 1 week, from the initial decision to full activation. Moreover, the unit functioned during the peak of the NYC COVID-19 epidemic largely as envisioned and required surprisingly few space or workflow modifications mid-course. Its success was due to the hard work of the leadership team and front-line providers and the collaboration across the institution.