Acute Crit Care.  2021 Aug;36(3):201-207. 10.4266/acc.2021.00402.

The Mount Sinai Hospital Institute for critical care medicine response to the COVID-19 pandemic

• Wang J
• Leibner E
• Hyman JB
• Ahmed S
• Hamburger J
• Hsieh J
• Dangayach N
• Tandon P
• Gidwani U
• Leibowitz A
• Kohli-Seth R
• On behalf of Mount Sinai Anesthesiology and Critical Care COVID19 Writing Grou

• KMID: 2519446
• DOI: http://doi.org/10.4266/acc.2021.00402

Abstract

Background
The coronavirus disease 2019 (COVID-19) pandemic resulted in a surge of critically ill patients. This was especially true in New York City. We present a roadmap for hospitals and healthcare systems to prepare for a Pandemic.
Methods
This was a retrospective review of how Mount Sinai Hospital (MSH) was able to rapidly prepare to handle the pandemic. MSH, the largest academic hospital within the Mount Sinai Health System, rapidly expanded the intensive care unit (ICU) bed capacity, including creating new ICU beds, expanded the workforce, and created guidelines.
Results
MSH a 1,139-bed quaternary care academic referral hospital with 104 ICU beds expanded to 1,453 beds (27.5% increase) with 235 ICU beds (126% increase) during the pandemic peak in the first week of April 2020. From March to June 2020, with follow-up through October 2020, MSH admitted 2,591 COVID-19-positive patients, 614 to ICUs. Most admitted patients received noninvasive support including a non-rebreather mask, high flow nasal cannula, and noninvasive positive pressure ventilation. Among ICU patients, 68.4% (n=420) received mechanical ventilation; among the admitted ICU patients, 42.8% (n=263) died, and 47.8% (n=294) were discharged alive.
Conclusions
Flexible bed management initiatives; teamwork across multiple disciplines; and development and implementation of guidelines were critical accommodating the surge of critically ill patients. Non-ICU services and staff were deployed to augment the critical care work force and open new critical care units. This approach to rapidly expand bed availability and staffing across the system helped provide the best care for the patients and saved lives.

Keyword

COVID-19; critical care; pandemics; surge capacity

Figure

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  Figure 1. Mount Sinai Hospital (MSH) coronavirus disease 2019 (COVID-19) intensive care unit (ICU) versus hospital admissions.

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  Figure 2. Force multiplier pyramid: a schema for critical care personnel expansion. ICU: intensive care unit; APP: advanced care practitioner; RN: registered nurse.

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