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Baum KD, Vlaanderen L, James W, Huppert MJ, Kettler P, Chell C, Shadiow A, Strike H, Greenlee K, Brown D, Hick JL, Wolf JM, Fiecas MB, McLachlan E, Seaberg J, MacDonnell S, Kesler S, Dichter JR. The Minnesota Medical Operations Coordination Center: A COVID-19 Statewide Response to Ensure Access to Critical Care and Medical-Surgical Beds. Chest 2024; 165:95-109. [PMID: 37597611 DOI: 10.1016/j.chest.2023.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND COVID-19 led to unprecedented inpatient capacity challenges, particularly in ICUs, which spurred development of statewide or regional placement centers for coordinating transfer (load-balancing) of adult patients needing intensive care to hospitals with remaining capacity. RESEARCH QUESTION Do Medical Operations Coordination Centers (MOCC) augment patient placement during times of severe capacity challenges? STUDY DESIGN AND METHODS The Minnesota MOCC was established with a focus on transfer of adult ICU and medical-surgical patients; trauma, cardiac, stroke, burn, and extracorporeal membrane oxygenation cases were excluded. The center operated within one health care system's bed management center, using a dedicated 24/7 telephone number. Major health care systems statewide and two tertiary centers in a neighboring state participated, sharing information on system status, challenges, and strategies. Patient volumes and transfer data were tracked; client satisfaction was evaluated through an anonymous survey. RESULTS From August 1, 2020, through March 31, 2022, a total of 5,307 requests were made, 2,008 beds identified, 1,316 requests canceled, and 1,981 requests were unable to be fulfilled. A total of 1,715 patients had COVID-19 (32.3%), and 2,473 were negative or low risk for COVID-19 (46.6%). COVID-19 status was unknown in 1,119 (21.1%). Overall, 760 were patients on ventilators (49.1% COVID-19 positive). The Minnesota Critical Care Coordination Center placed most patients during the fall 2020 surge with the Minnesota Governor's stay-at-home order during the peak. However, during the fall 2021 surge, only 30% of ICU patients and 39% of medical-surgical patients were placed. Indicators characterizing severe surge include the number of Critical Care Coordination Center requests, decreasing placements, longer placement times, and time series analysis showing significant request-acceptance differences. INTERPRETATION Implementation of a large-scale Minnesota MOCC program was effective at placing patients during the first COVID-19 pandemic fall 2020 surge and was well regarded by hospitals and health systems. However, under worsening duress of limited resources during the fall 2021 surge, placement of ICU and medical-surgical patients was greatly decreased.
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Affiliation(s)
- Karyn D Baum
- Essentia Health, Duluth, MN; University of Minnesota, Minneapolis, MN
| | - Lauren Vlaanderen
- M Health Fairview, Minneapolis, MN; Scope Anesthesia of North Carolina PLLC, Charlotte, NC
| | | | | | | | - Christine Chell
- Metro Health & Medical Preparedness Coalition, Minneapolis, MN
| | | | | | | | | | - John L Hick
- University of Minnesota, Minneapolis, MN; Hennepin Healthcare, Minneapolis, MN
| | | | | | - Erin McLachlan
- Minnesota Department of Health, St. Paul, MN; Hennepin Healthcare, Minneapolis, MN
| | - Judy Seaberg
- Minnesota Department of Health, St. Paul, MN; Hennepin Healthcare, Minneapolis, MN
| | - Sean MacDonnell
- Minnesota Department of Health, St. Paul, MN; Hennepin Healthcare, Minneapolis, MN
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Dichter JR, Devereaux AV, Sprung CL, Mukherjee V, Persoff J, Baum KD, Ornoff D, Uppal A, Hossain T, Henry KN, Ghazipura M, Bowden KR, Feldman HJ, Hamele MT, Burry LD, Martland AMO, Huffines M, Tosh PK, Downar J, Hick JL, Christian MD, Maves RC. Mass Critical Care Surge Response During COVID-19: Implementation of Contingency Strategies - A Preliminary Report of Findings From the Task Force for Mass Critical Care. Chest 2021; 161:429-447. [PMID: 34499878 PMCID: PMC8420082 DOI: 10.1016/j.chest.2021.08.072] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/05/2021] [Accepted: 08/19/2021] [Indexed: 01/25/2023] Open
Abstract
Background After the publication of a 2014 consensus statement regarding mass critical care during public health emergencies, much has been learned about surge responses and the care of overwhelming numbers of patients during the COVID-19 pandemic. Gaps in prior pandemic planning were identified and require modification in the midst of severe ongoing surges throughout the world. Research Question A subcommittee from The Task Force for Mass Critical Care (TFMCC) investigated the most recent COVID-19 publications coupled with TFMCC members anecdotal experience in order to formulate operational strategies to optimize contingency level care, and prevent crisis care circumstances associated with increased mortality. Study Design and Methods TFMCC adopted a modified version of established rapid guideline methodologies from the World Health Organization and the Guidelines International Network-McMaster Guideline Development Checklist. With a consensus development process incorporating expert opinion to define important questions and extract evidence, the TFMCC developed relevant pandemic surge suggestions in a structured manner, incorporating peer-reviewed literature, “gray” evidence from lay media sources, and anecdotal experiential evidence. Results Ten suggestions were identified regarding staffing, load-balancing, communication, and technology. Staffing models are suggested with resilience strategies to support critical care staff. ICU surge strategies and strain indicators are suggested to enhance ICU prioritization tactics to maintain contingency level care and to avoid crisis triage, with early transfer strategies to further load-balance care. We suggest that intensivists and hospitalists be engaged with the incident command structure to ensure two-way communication, situational awareness, and the use of technology to support critical care delivery and families of patients in ICUs. Interpretation A subcommittee from the TFMCC offers interim evidence-informed operational strategies to assist hospitals and communities to plan for and respond to surge capacity demands resulting from COVID-19.
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Affiliation(s)
| | | | | | | | | | | | | | - Amit Uppal
- Grossman School of Medicine, New York University, New York, NY
| | - Tanzib Hossain
- Grossman School of Medicine, New York University, New York, NY
| | | | - Marya Ghazipura
- Grossman School of Medicine, New York University, New York, NY
| | | | - Henry J Feldman
- Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Cambridge, MA
| | - Mitchell T Hamele
- Uniformed Services University, Bethesda, MD; Tripler Army Medical Center, Honolulu, HI
| | | | | | | | | | | | - John L Hick
- University of Minnesota, Minneapolis, MN; Hennepin Health Care, Minneapolis, MN
| | - Michael D Christian
- Research & Clinical Effectiveness Lead/HEMS Doctor, London's Air Ambulance, Bart's NHS Health Trust, London, England
| | - Ryan C Maves
- Uniformed Services University, Bethesda, MD; Wake Forest School of Medicine, Winston-Salem, NC
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Zebrowski A, Rundle A, Pei S, Yaman T, Yang W, Carr BG, Sims S, Doorley R, Schluger N, Quinn JW, Shaman J, Branas CC. A Spatiotemporal Tool to Project Hospital Critical Care Capacity and Mortality From COVID-19 in US Counties. Am J Public Health 2021; 111:1113-1122. [PMID: 33856876 DOI: 10.2105/ajph.2021.306220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To create a tool to rapidly determine where pandemic demand for critical care overwhelms county-level surge capacity and to compare public health and medical responses.Methods. In March 2020, COVID-19 cases requiring critical care were estimated using an adaptive metapopulation SEIR (susceptible‒exposed‒infectious‒recovered) model for all 3142 US counties for future 21-day and 42-day periods from April 2, 2020, to May 13, 2020, in 4 reactive patterns of contact reduction-0%, 20%, 30%, and 40%-and 4 surge response scenarios-very low, low, medium, and high.Results. In areas with increased demand, surge response measures could avert 104 120 additional deaths-55% through high clearance of critical care beds and 45% through measures such as greater ventilator access. The percentages of lives saved from high levels of contact reduction were 1.9 to 4.2 times greater than high levels of hospital surge response. Differences in projected versus actual COVID-19 demands were reasonably small over time.Conclusions. Nonpharmaceutical public health interventions had greater impact in minimizing preventable deaths during the pandemic than did hospital critical care surge response. Ready-to-go spatiotemporal supply and demand data visualization and analytics tools should be advanced for future preparedness and all-hazards disaster response.
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Affiliation(s)
- Alexis Zebrowski
- Alexis Zebrowski and Brendan G. Carr are with the Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Rundle, Tonguc Yaman, Wan Yang, James W. Quinn, and Charles C. Branas are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York. Sen Pei and Jeffrey Shaman are with the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University. Sarah Sims is with Patient Insight, Santa Monica, CA. Ronan Doorley is with Media Lab at the Massachusetts Institute of Technology, Cambridge. Neil Schluger is with the Division of Pulmonary, Allergy, and Critical Care Medicine, and Departments of Epidemiology and Environmental Health Sciences, Columbia University Irving Medical Center, Columbia University
| | - Andrew Rundle
- Alexis Zebrowski and Brendan G. Carr are with the Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Rundle, Tonguc Yaman, Wan Yang, James W. Quinn, and Charles C. Branas are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York. Sen Pei and Jeffrey Shaman are with the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University. Sarah Sims is with Patient Insight, Santa Monica, CA. Ronan Doorley is with Media Lab at the Massachusetts Institute of Technology, Cambridge. Neil Schluger is with the Division of Pulmonary, Allergy, and Critical Care Medicine, and Departments of Epidemiology and Environmental Health Sciences, Columbia University Irving Medical Center, Columbia University
| | - Sen Pei
- Alexis Zebrowski and Brendan G. Carr are with the Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Rundle, Tonguc Yaman, Wan Yang, James W. Quinn, and Charles C. Branas are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York. Sen Pei and Jeffrey Shaman are with the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University. Sarah Sims is with Patient Insight, Santa Monica, CA. Ronan Doorley is with Media Lab at the Massachusetts Institute of Technology, Cambridge. Neil Schluger is with the Division of Pulmonary, Allergy, and Critical Care Medicine, and Departments of Epidemiology and Environmental Health Sciences, Columbia University Irving Medical Center, Columbia University
| | - Tonguc Yaman
- Alexis Zebrowski and Brendan G. Carr are with the Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Rundle, Tonguc Yaman, Wan Yang, James W. Quinn, and Charles C. Branas are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York. Sen Pei and Jeffrey Shaman are with the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University. Sarah Sims is with Patient Insight, Santa Monica, CA. Ronan Doorley is with Media Lab at the Massachusetts Institute of Technology, Cambridge. Neil Schluger is with the Division of Pulmonary, Allergy, and Critical Care Medicine, and Departments of Epidemiology and Environmental Health Sciences, Columbia University Irving Medical Center, Columbia University
| | - Wan Yang
- Alexis Zebrowski and Brendan G. Carr are with the Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Rundle, Tonguc Yaman, Wan Yang, James W. Quinn, and Charles C. Branas are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York. Sen Pei and Jeffrey Shaman are with the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University. Sarah Sims is with Patient Insight, Santa Monica, CA. Ronan Doorley is with Media Lab at the Massachusetts Institute of Technology, Cambridge. Neil Schluger is with the Division of Pulmonary, Allergy, and Critical Care Medicine, and Departments of Epidemiology and Environmental Health Sciences, Columbia University Irving Medical Center, Columbia University
| | - Brendan G Carr
- Alexis Zebrowski and Brendan G. Carr are with the Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Rundle, Tonguc Yaman, Wan Yang, James W. Quinn, and Charles C. Branas are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York. Sen Pei and Jeffrey Shaman are with the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University. Sarah Sims is with Patient Insight, Santa Monica, CA. Ronan Doorley is with Media Lab at the Massachusetts Institute of Technology, Cambridge. Neil Schluger is with the Division of Pulmonary, Allergy, and Critical Care Medicine, and Departments of Epidemiology and Environmental Health Sciences, Columbia University Irving Medical Center, Columbia University
| | - Sarah Sims
- Alexis Zebrowski and Brendan G. Carr are with the Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Rundle, Tonguc Yaman, Wan Yang, James W. Quinn, and Charles C. Branas are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York. Sen Pei and Jeffrey Shaman are with the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University. Sarah Sims is with Patient Insight, Santa Monica, CA. Ronan Doorley is with Media Lab at the Massachusetts Institute of Technology, Cambridge. Neil Schluger is with the Division of Pulmonary, Allergy, and Critical Care Medicine, and Departments of Epidemiology and Environmental Health Sciences, Columbia University Irving Medical Center, Columbia University
| | - Ronan Doorley
- Alexis Zebrowski and Brendan G. Carr are with the Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Rundle, Tonguc Yaman, Wan Yang, James W. Quinn, and Charles C. Branas are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York. Sen Pei and Jeffrey Shaman are with the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University. Sarah Sims is with Patient Insight, Santa Monica, CA. Ronan Doorley is with Media Lab at the Massachusetts Institute of Technology, Cambridge. Neil Schluger is with the Division of Pulmonary, Allergy, and Critical Care Medicine, and Departments of Epidemiology and Environmental Health Sciences, Columbia University Irving Medical Center, Columbia University
| | - Neil Schluger
- Alexis Zebrowski and Brendan G. Carr are with the Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Rundle, Tonguc Yaman, Wan Yang, James W. Quinn, and Charles C. Branas are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York. Sen Pei and Jeffrey Shaman are with the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University. Sarah Sims is with Patient Insight, Santa Monica, CA. Ronan Doorley is with Media Lab at the Massachusetts Institute of Technology, Cambridge. Neil Schluger is with the Division of Pulmonary, Allergy, and Critical Care Medicine, and Departments of Epidemiology and Environmental Health Sciences, Columbia University Irving Medical Center, Columbia University
| | - James W Quinn
- Alexis Zebrowski and Brendan G. Carr are with the Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Rundle, Tonguc Yaman, Wan Yang, James W. Quinn, and Charles C. Branas are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York. Sen Pei and Jeffrey Shaman are with the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University. Sarah Sims is with Patient Insight, Santa Monica, CA. Ronan Doorley is with Media Lab at the Massachusetts Institute of Technology, Cambridge. Neil Schluger is with the Division of Pulmonary, Allergy, and Critical Care Medicine, and Departments of Epidemiology and Environmental Health Sciences, Columbia University Irving Medical Center, Columbia University
| | - Jeffrey Shaman
- Alexis Zebrowski and Brendan G. Carr are with the Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Rundle, Tonguc Yaman, Wan Yang, James W. Quinn, and Charles C. Branas are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York. Sen Pei and Jeffrey Shaman are with the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University. Sarah Sims is with Patient Insight, Santa Monica, CA. Ronan Doorley is with Media Lab at the Massachusetts Institute of Technology, Cambridge. Neil Schluger is with the Division of Pulmonary, Allergy, and Critical Care Medicine, and Departments of Epidemiology and Environmental Health Sciences, Columbia University Irving Medical Center, Columbia University
| | - Charles C Branas
- Alexis Zebrowski and Brendan G. Carr are with the Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Andrew Rundle, Tonguc Yaman, Wan Yang, James W. Quinn, and Charles C. Branas are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York. Sen Pei and Jeffrey Shaman are with the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University. Sarah Sims is with Patient Insight, Santa Monica, CA. Ronan Doorley is with Media Lab at the Massachusetts Institute of Technology, Cambridge. Neil Schluger is with the Division of Pulmonary, Allergy, and Critical Care Medicine, and Departments of Epidemiology and Environmental Health Sciences, Columbia University Irving Medical Center, Columbia University
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