Mount sinai hospital institute for critical care medicine COVID-19 pandemic policies and procedures

ABSTRACT

INTRODUCTION: COVID-19 2020 pandemic with New York City (NYC) as the epicenter necessitated an unprecedented increase in critical care capacity and development of institutional guidelines for care. We describe our drastic increased ICU capacity and how we created and disseminated our guidelines. We hope our experiences help others manage their COVID-19 peaks. METHODS: Mount Sinai Hospital System includes a medical school and eight campuses, the largest being Mount Sinai Hospital (MSH). Since 2013, MSH had system-wide staffing models, cross credentialed staff, and combined leadership. MSH has and Institute for Critical Care Medicine (ICCM) that includes seven adult ICUs, 45 critical care faculty, rapid response team (RRT), vascular access team (VAS), difficult airway team (DART), patient safety quality team (PSQ), clinical research team, and post-ICU recovery clinic. ICCM coordinated COVID-19 critical care response within MSHS. ICCM, Emergency Medicine, Anesthesiology, and Infection Prevention helped develop systemwide guidelines on our COVID-19 website accessible to all hospital employees. RESULTS: MSH expanded from 1139-beds, 104 ICU beds, to 1453 beds, 235 ICU beds during the COVID-19 peak. CONCLUSIONS: MSH's response to COVID-19 surge by expanding critical care bed capacity from 104 to over 200 ICU beds required teamwork across disciplines. We developed new guidelines for airway management, cardiac arrest, anticoagulation, vascular access, and proning that helped streamline workflow and accommodate 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 expanding bed availability and staffing across the system was made possible by the collaboration between ICCM, emergency department, anesthesia department, and infection prevention, and helped to provide the best care for our patients and saved lives.