5 lessons for the ICU from COVID-19

On the positive side, we are now perhaps wiser. COVID-19 has reminded us how important a strong acute hospital system is for withstanding the unique challenges of a pandemic. To prevent their hospitals from being overwhelmed, governments with few intensive care beds carefully controlled virus exposure through lockdowns, travel restrictions and quarantine. Consider the difference in behaviour of the NSW government, where there are 10.8 ICU beds per 100,000 population, and New Zealand, where there are only 3.6 beds (i). During 2021/2022 NSW was relatively open and adventurous whilst New Zealand remained tightly closed for most of the past 2 years. On the other end of the critical care capacity spectrum is Germany, with 33.9 beds and the United States with 28.9 beds per 100,000 population (ii). This is a vast difference in hospital resourcing and pandemic resilience.

Beyond the importance of adequate ICU capacity, what else has Covid taught us? Here are our 5 key takeaways thus far:

1. Efficiency is essential – During the COVID-19 pandemic we saw an unprecedented increase in demand for hospital care while at the same time the workforce was itself reduced by illness and virus exposure. The remaining staff therefore need tools to help them work as efficiently as possible.
2. Team work matters – Despite being exhausted and working under very difficult conditions, ICU staff have reported that Ventilated patients need a high level of care and usually stay for longer than typical ICU patients. the pandemic we’ve seen extended lengths of stay (iii) and the need for makeshift teams to come together in new ways. Teams need shared access to information and clarity on patient status, progress and next steps.
3. Be adaptable – To cope with demand surges, ICUs need to be able to reconfigure as surge capacity is added and removed. Adaptability also means modifying processes and systems to enable staff brought in from other areas to work safely and effectively in the ICU.
4. Attract and retain staff – Health systems all over the world have realised the importance of ICU capacity and that this capacity hinges on the availability of skilled nurses. Global demand and competition for skilled nursing staff is at an all-time high. The UK’s NHS has pledged to add 50,000 nurses by 2025. Hospitals that offer staff a positive and effective work environment will have the edge over others that continue to rely on laborious, manual and paper driven processes.
5. This will happen again – We need to prepare now for the next pandemic.

Digital health tools like the MetaVision solution (by iMDsoft) for intensive care have helped hospitals around the world meet the challenges of COVID-19. Paper based process are difficult at the best of times. Hard to find or missing information wastes precious time and increases the chance of mistakes. ICUs operating under the extreme pressure of a COVID-19 surge need instant access to patient information, easy protocol guidance and electronic medication management.

Sources

1. https://www.mja.com.au/journal/2021/215/11/increasing-icu-capacity-accommodate-higher-demand-during-covid-19-pandemic#2
2. OECD Policy Brief on the response to the Covid-19 crisis (20/4/2020) https://www.oecd.org/coronavirus/en/data-insights/intensive-care-beds-capacity
3. https://www.mja.com.au/journal/2021/214/1/outcomes-patients-covid-19-admitted-australian-intensive-care-units-during-first#:~:text=The%20median%20ICU%20length%20of,0.001)%20(Box%204).