During this coronavirus pandemic, hospitals have had to reorganize their structure. Intensive care units have been the focus of this reorganization. In this article, we will explain the restructuring of the new intensive care departments.
The Increased Demand
As COVID-19 cases have grown, the number of critically ill patients has also shown a sudden increase. At first, they were placed in existing intensive care facilities together with other patients. The need of allocating new intensive care units, exclusively for COVID-19 patients, soon became more evident.
Intensive Care Units Dedicated to COVID-19 Patients
A certain number of existing intensive care departments have been selected and reserved for patients affected by COVID-19. With the increasing number of patients in need of intensive care, it soon became clear that there weren’t enough places available in the hospitals. As a result, other areas of the hospitals, those intended for other uses, had to be repurposed as additional intensive care facilities.
Creation of Dedicated Facilities
Hospitals went from having only 1 intensive care unit (with 4-8 beds) to 2-4 intensive care units dedicated solely to COVID-19 patients. Thus, hospitals increased their places from having an average of only 6-8 beds to having around 40 beds! Where did all these facilities come from?
In some cases, existing facilities have been repurposed. For example, intensive care units intended for cardiac surgery have been dedicated to patients affected by the virus. In this case, no modifications of any kind were made to the facilities themselves.
Operating theatres have been repurposed as well. Instead of performing surgeries, which have been permanently suspended, every operating room has been transformed into an intensive care unit, replacing the existing equipment with beds. Each room has been filled with 2 to 4 beds, ventilators, dialysis machines, and infusion pumps.
The recovery rooms of operating theatres in some hospitals have become resuscitation rooms.
In other cases, where operating theatres were not enough, new intensive care units have been built from scratch. New dedicated facilities have been created to receive the many patients in need. All the materials were brought in a hurry and an entire department was set up in just over a week.
New Room Logistics
In all this turmoil, health workers had to change and adapt their way to work. The first important difference is between the “open plan” and the “single room” intensive therapy units.
Intensive Therapy Units: Open Plan
These are large open plan rooms where all patients and staff are together. Workstations with computers etc. are also included here. In this type of room, the virus can easily spread everywhere. The staff at work wear full protection at all times.
- All communication between the staff happens quickly because everybody is in the same room.
- The unique working environment allows for greater “closeness” and collaboration.
- Health workers do not have to change clothes frequently, and therefore there is less waste of protective equipment.
- Greater mental organisation: When you are at work, you are aware that you are in an environment at risk.
- Taking breaks is not always possible for the staff – tiredness and frustration levels may be high;
- Working on the computer is more challenging when wearing double gloves and being in a noisy environment;
- Communication between staff is limited to no more than a few precise orders.
Intensive Therapy Units: Private Rooms
Private rooms with multiple beds provide a separate space for infected patients, doctors, and other health workers. In their separate area, doctors and nurses can carry out other activities which do not require contact with patients.
What are these activities? Here are the most common ones:
- Prescribing medicines
- Requesting and evaluating tests
- Communicating with colleagues in choosing the most appropriate therapies for patients
All these activities do not normally take place in the same environment where patients are located.
The virus is present in inpatient rooms, but not in external ones; this has several advantages and disadvantages compared to the open plan system.
- The staff can alternate between care activities and technical or admin activities in different environments.
- The staff can also alternate between tiring activities with less demanding ones.
- There is less fatigue and frustration during shifts, and thus a greater possibility to perform longer shifts with more efficiency;
- There is also greater efficiency and concentration during administrative tasks.
- The unique working environment allows for greater “closeness” and collaboration of the staff.
- Operators need to change more frequently, and therefore, there is an increased use of personal protective equipment.
- Increased mental organisation: When you are at work, you are aware that you are in an environment at risk.
- There may be communication problems between the staff who care for the patients and the management personnel.
- There is a need for specific communication systems.
In this article we discovered how intensive care units dedicated to COVID-19 patients are organised. We will continue this journey and discover more in future articles.
Dr. Marco De Nardin