How a healthcare system leveraged ICU patient load balancing to manage the COVID-19 pandemic surge

ABSTRACT

INTRODUCTION: Beth Israel Lahey Health (BILH) formed in March 2019 incorporating 2 legacy systems and 3 independent hospitals. In March 2020, during the surge of COVID-19 in MA, BILH formed a Critical Care Group (CCG) to assist patient load balancing and equipment leveling across all 12 hospitals. METHODS: CCG members included ICU leaders from 3 tertiary hospitals and the BILH Chief Medical Officer. The team huddled twice daily, and developed ICU bed and ventilator surge plans, and pathways for balancing across the network. Requests for transfers from referring hospitals were redirected to BILH hospitals with capacity. CCG made strategic decisions to transfer patients within BILH so that no single hospital became overwhelmed. CCG invited 3 Safety Net Hospitals (SNHs) to the huddles;each SNH was in a COVID ?hotspot,? and the CCG accommodated their transfers. RESULTS: The CCG enabled BILH to flex to 238% of the system's baseline 224 licensed ICU beds. At peak, BILH's tertiary hospital ICUs had an occupancy at 157% of baseline, with 73% of ICU patients on ventilators. From 3/1-6/30, one of the tertiary BILH hospitals accepted 81 SNH ICU transfers;support for SNHs was critical for the overall State response to the surge. Unexpected benefits of the CCG included providing a platform for communication and knowledge sharing;discussions included standardization for tracheostomy procedures, management of ECMO resources, avoidance of pitfalls using anesthesia machines as ventilators, and protocols for proning. As a new system, these strengthened relationships between legacy hospital systems. In addition, MA developed a similar CCG, with the aim of the state's largest hospitals having awareness of how other hospitals' ICUs were managing the surge. CONCLUSIONS: CCG was essential to the BILH system as it facilitated a real-time adaptive response to the surge. Key elements included 1) Creating a team of senior Critical Care leadership, all of whom were closely in tune with their respective ICU's current status and needs 2) CCG relied on a dashboard that provided daily data on ICU capacity at each hospital, allowing for real-time decision-making 3) Early planning prior to the influx of patients;the CCG formed when the COVID critical care census system-wide was 5, relative to a census of 190 at peak surge.