Service Review of an Enhanced Respiratory Care Area Developed in Response to the Covid-19 Pandemic

ABSTRACT

Introduction: During the second wave of the COVID-19 pandemic, regional modelling predicted an acute surge in the demand for level 2 respiratory beds. Locally, these patients were cared for on the ICU.Capacity expanded from20 to 42 beds in response to the pandemic, but the anticipated demand could not be met in the existing critical care footprint. Early evidence suggested that CPAP and high-flow oxygen could reduce the requirement for mechanical ventilation by up to 50% for patients with Covid-19.1-2 Objectives and Methods: • An enhanced respiratory care a rea was created for a cohort of level 2 respiratory patients to provide CPAP and High-Flow oxygen on a 14 practitioner to patient ratio with the aim of relieving staffing and bed pressures on ICU whilst providing equitable care and outcomes to that given to patients on the main unit • Admission criteria stipulated patients should have either single organ failure, independence with self-care, capacity and/or pre-established escalation status • The area was staffed by an acute care team, a team of practitioners from a variety of professional backgrounds including nursing and AHP's who normally provided the Trust's citical care outreach and acute care support through advanced cinical practitioners, non-medical prescribers, practitioners, and specialist HCAs. Physiotherapists and junior doctors were assigned to the unit and supported with their typical professional roles and bedside care. • A service review was undertaken including analysis of admission data, length of stay and unit mortality. A retrospective clinical audit measuring care delivered against the area's initial standard operating procedure and objectives was also undertaken against 15% of patient notes. Results: •67 patients admitted over 40 days •247 critical care bed days saved •Median length of stay 3.68 days •50.7% patients stepped down to wards;34.3% escalated to critical care;14.9% died. •Median age 63, 21 male female ratio Conclusion: The enhanced respiratory care area provided an innovative response to the local critical care COVID-19 bed crisis by cohorting level 2 respiratory patients and transformational workforce planning and care modelling. This enabled a rapid and targeted response to the crisis which provided quality care that was at least equivalent to the length of stay and mortality outcomes of the local ICU, whilst significantly reducing ICU bed and workforce pressures.