VII. Manpower Allocation

July 27, 2020

• Design for Implementation of a System-Level ICU Pandemic Surge Staffing Plan. 7/23/20. Thakur N. Crit Care Explor.
  Authors provide a comprehensive description of the design, dissemination, and implementation of an algorithm for multidisciplinary critical care staffing during surge demand, as implemented by a 40-hospital multi-state healthcare system. Staff is tiered according to skills and experience with team leadership roles for the most appropriate. On-site and telemedicine supervision are employed to optimally leverage oversight and scaling of patient loads. The plan provides for doubling of 750 ICU beds out of a total 5,500 beds. Consistent terminology and role-definition facilitate redeployment and allocation of human resources to meet changing local needs across diverse hospitals.

May 22, 2020

• Return to work for healthcare workers with confirmed COVID-19 infection. May 20. Zhang. Occup Med (Lond).
  A Canadian Occupational Medicine editorial addressing the confusion created by a discrepancy between guidelines addressing safe return to work for health care workers recovering from COVID-19. The US CDC offers two strategies and requires either two negative naso-pharyngeal swabs taken 24 hours apart or a non-testing approach based on symptom resolution (10 days since symptoms or 72 hrs since recovery). Public Health England recommends return after day 7 of symptom onset, provided clinical improvement has occurred and the health care worker has been afebrile for 48 hours.
  The authors suggest a pragmatic approach that uses cessation of clinical symptoms backed up by serology to prove non-infectivity.

May 8, 2020

• Strategies for daily operating room management of ambulatory surgery centers following resolution of the acute phase of the COVID-19 pandemic. May 7. Dexter. J Clin Anesth.
  Opinion from SAB Members: Drs. J. Lance Lichtor and David Clement
  JLL: Strategies for daily operating room management of ambulatory surgery centers following resolution of the acute phase of the COVID-19 pandemic. Excessive detail for that which is obvious. Though not stated the percent of operations that use Bovie, surely a high percentage and not discussed but that also can produce an aerosol.
  DC: Practical suggestions for maintaining safety while increasing volume of elective surgeries as ORs gradually ramp up. Suggestions include maximizing regional anesthesia and MAC anesthesia, designating different ORs for AGPs and non-AGPs, minimizing PACU use, alternating a pair of ORs for each surgical team etc. Though mostly common sense, these approaches are different than traditional OR practice, and will be useful for front-line workers to consider.

April 29, 2020

• Innovative ICU Physician Care Models: Covid-19 Pandemic at New York-Presbyterian
  Apr 28. Kumaraiah. NEJM Catalyst.
  Opinion from SAB Member: Dr. W. Heinrich Wurm
  Stunning description of the strategy, innovation, collaboration and compassion that propelled NYC health care providers to rise to the challenge of creating and staffing 550 additional critical care beds as the COVID-19 pandemic surged. The ingredients for success were flexibility, sharing best practices and deploying teams across a vast enterprise. A must read for all of us.

April 21, 2020

• Calculate the COVID-19 equation with the people’s energy as key variable. Apr 19. Boggs. Anesth Analg.
  Editorial covering 1 Swiss study dealing with manpower modeling for ICUs, a correspondence paper from Beijing on HCP protection and an editorial accompanying an article on burnout from Zambia.
  The previously reviewed critical care staffing simulation was felt to be somewhat flawed as it assumed a fixed rate of infection as well as mortality. The Chen article describes the various stages the Chinese HCS went through as the pandemic accelerated: Lack of knowledge, lack of PPE, Knowledge restored, PPE available.

April 15, 2020

• Medical Student Mobilization During A Crisis: Lessons From A COVID-19 Medical Student Response Team. Apr 14. Soled. Acad Med.
  Outline of an impressive response by Harvard medical students following their dismissal from clinical duties on March 17 in the form of educational outreach to the medical community and the general public as well as on-line social media activism in both clinical support and community outreach.

April 13, 2020

• COVID-19: Operational guidance for maintaining essential health services during an outbreak. Mar 25. WHO Department of Communications. WHO.
  This is a timely roadmap for healthcare systems world-wide outlining a structured approach towards identifying essential health care services during the COVID-19 epidemic. Triggered by painful lessons learned from the 2014/15 Ebola outbreak, when more people died from vaccine preventable and treatable conditions like measles, malaria, tuberculosis and HIV/AIDS than from Ebola, this document applies to chemotherapy, radiation and many other urgent diagnostic and therapeutic measures as well. Timely, this brochure covers a wide range of essential steps ranging from re-training of personnel to planning for financial support and securing supply lines. It is a well-written comprehensive guide towards survival of COVID-19 while addressing and preventing collateral damage.

April 11, 2020

• Staffing with disease-based epidemiologic indices may reduce shortage of intensive care unit staff during the COVID-19 pandemic. Apr 7. Mascha. Anesthesia & Analgesia.
  Interesting exercise comparing two ICU staffing models and subjecting them to a number of simulations with varying incidents of illness and even death among health care workers and a 3 week recovery period. Properly validated, this exercise has great predictive value for critical care unit staffing – now, or for future contingency planning.

April 10, 2020

• “We Signed Up for This!” Student and Trainee Responses to the Covid-19 Pandemic. Apr 9. Gallagher. NEJM.
  Well written and thoughtful perspective from the University of Washington providing a status update on the role of medical students (clinical rotations were suspended in mid-March) as well as reporting on and discussion of the results of a survey among residents and medical students on the impact of the current situation. A call for administrators and teachers to communicate, listen and be aware of the duplicity of emotions among young clinicians wishing to serve as well as protect themselves and others and a realization of the multitude of once theoretical dilemmas that now become real in our daily practice.

April 7, 2020

• Emergency Restructuring of a General Surgery Residency Program During the Coronavirus Disease 2019 Pandemic: The University of Washington Experience. Apr 6. Nassar. JAMA Surgery.
  Outlines emergency restructuring of the facility’s general surgery resident care teams in an attempt to optimize workforce well-being, comply with physical distancing requirements, and continue excellent patient care at the University of Washington Department of Surgery in Seattle.

April 3, 2020

• Medical student involvement in the COVID-19 response. Apr 2. Representatives of STARSurg Collaborative, EuroSurg Collaborative, and TASMAN Collaborative. The Lancet.
  Discusses the various responses governments and medical schools have taken to address medical student learning during the COVID-19 pandemic.

April 1, 2020

• Covid-19: What do trainees need to know? Mar 27. Hallett. BMJ.
  Questions answered on how the COVID-19 pandemic might affect trainees.
• How can I cope with redeployment? Mar 30. Rimmer. BMJ.
  Discusses how trainees may deal with working in unfamiliar environments during the COVID-19 pandemic.
• States Get Creative To Find And Deploy More Health Workers In COVID-19 Fight. Mar 25. Simmons-Duffin. npr.
  Calls from some states in the U.S. to re-deploy retired health workers.

March 27, 2020

• Quick ICU Retraining for Intensivists to Meet Demands of COVID-19 including educational materials, short cheat sheets and one-page guides, triage guidelines and other pandemic related resources. Circulated: March 27, 2020.