POCC COVID surge response

Video Abstract

Click on the following image to view a short video abstract of this project.

Background

Through the pandemic, 45% of all Covid-19 cases in Victoria have resided in the Western Health catchment. Severe illness related to Covid-19 virus had a significant impact on Western Health (WH) ‘business as usual’ operations. To care for the increased numbers of patients with Covid illness requiring Intensive Care at Western Health, the units expanded by 83% into four subunits, and a new Model of Care was introduced in order to maintain safe care.

This was only possible through the enormous dedication and willingness of staff from across the organisation to support the sickest of our patients in these units.

Methods

This initiative aligned with Western Health’s priority to provide the best possible care to every patient, every time, everywhere, even in an environment of unprecedented healthcare demand. In line with pandemic surge planning, additional ICU capacity was created in the neighbouring sleep laboratory at Footscray Hospital and the ‘Post-Operative Recovery Room’ at Sunshine.

To open every one additional ICU bed, 5.6 EFT of nursing staff plus additional medical staff and support team staff is required. As there was no capacity to almost double the workforce nor time to recruit staff, Western Health took the opportunity provided by a health sector wide pause in elective surgery to mobilise the transfer of staff from surgical areas to ICU.

Whilst this strategy expedited the required numbers of nursing staff to be working in ICU, the skillset of the staff moved to work in ICU did not match the needs of ICU patients. ICU is an extremely different environment to operating theatres and the nursing responsibilities and clinical interventions are different to those a theatre nurse would have experienced. ICU is loud, stressful, and full of unique medical equipment that take years to learn and be adept in managing. Underpinning this knowledge is all ICU nursing staff have a post-graduate qualification in ICU/ critical care nursing.

To support the ICU team and the relocated peri-operative and surgical ward nursing staff to care for the increasing numbers of patients in ICU, the following were implemented;

• A nursing ‘buddy model’ where ICU nurses partnered with Registered Nurses who completed upskilling programs and orientation shifts to ensure all beds were safely staffed to meet the surge demand. 1 ICU trained nurse worked with 1 Peri-operative or surgical ward registered nurse to care for 2 patients.
• 12 hour shifts to ensure 24 hour a day coverage of nursing staff using the buddy model.
• The theatre and surgical ward nursing staff were supported by additional nurse education staff.
• The anaesthesia medical team also worked in ICU to support the ICU medical and the Critical Care Outreach team. This was essential due to the high demand for urgent medical response to very unwell and deteriorating patients on the wards.
• Security services supported the ICU teams by being onsite 24 hours a day. Unfortunately this was required due to a number of incidents of violence and threatened violence directed towards staff by members of the public who had opposing views on Covid-19 management of their loved ones.
• Onsite psychologist and counselling support and daily debrief sessions.

The additional educational support was also underpinned with a framework of staff wellbeing and psychological care strategies, including staff meals, vouchers, snack trolleys, take home packs, and care packages.

Results

Western Health sought to safely care for all patients in ICU and those needing timely access to ICU care, both for Covid-19 and non-Covid conditions. To do so, we aimed to utilise alternate clinical space to expand the ICU footprint and implement novel support systems and a modified model of care enabling perioperative and surgical staff to work as part of Western Health’s ICU teams to provide safe, timely and quality patient care.

The community supported by Western Health has been significantly impacted by Covid-19.  Significant planning was undertaken at Western Health to manage the surge demand of patients who were hospitalised with the virus.  This planning enabled Western Health to manage the demand from March 2020 – October 2021. However in the first week of October 2021, the demand for ICU beds at Western Health began to exceed the points of care available.

The next level of pandemic surge service delivery needed to be enacted rapidly, involving creating additional ICU capacity and mobilising an expanded workforce who could be supported to provide safe, quality specialist care in an ICU setting.

Outcomes

In “business as usual” times, Western Health has 9 ICU beds at both the Sunshine and Footscray Hospitals. From October 2021 – March 2022, the combined ICU’s were able to care for an average of 24 patients on the majority of days. At its peak, there were 33 ICU patients in Western Health’s ICU’s or 83% more than ‘business as usual’.

90 staff from across Western health were redeployed to care for the sickest of Covid patients in the surge model of care.

Western Health were able to safely care for the 840 patients who needed Intensive Care from October – March 2022. 34% of these patients were admitted with an illness directly caused by Covid-19 virus.

All peri-operative and surgical ward nurses who worked in ICU have since returned to their substantive roles. This successful model of care to rapidly create additional ICU capacity and mobilise an expanded workforce is now factored into surge planning and can be re-instated if required and appropriate.

Access to employee support through the WH assistance program and onsite counselling has been maintained.

In addition, further critical care nursing training opportunities have been explored and implemented.

This strategy was achieved within operational budget when solutions were required to support unprecedented ICU demand and the health sector pausing of elective surgery provided an innovative staff solution to meet this need.

Conclusion

Unprecedented demand for intensive care services required an innovative solution to ICU capacity and staffing. The use of alternate clinical space, workforce and implementation of novel support systems enabling perioperative and surgical staff to work as part of Western Health’s ICU teams allowed 840 patients to access required intensive care in a 6 month period.

These systems supported the ICU team to continue to provide high quality care to patients with staff who were relocated to work in an unfamiliar and highly specialised clinical area.

The success of this strategy from a staff perspective is reflected in the number of surgical staff who have decided to continue to pursue a career in critical care nursing. It is also testament to the enormous dedication and willingness of staff from across the organisation to support the sickest of our patients in the most challenging of times.