Two ICU Units Added in a 72-Hour Marathon of Innovation and Collaboration
The caregivers of COVID-19 patients knew they needed more rooms and ventilators. Einstein Medical Center Philadelphia is in the epicenter of the viral outbreak, physically located amid neighborhoods rife with infection. The hospital is among those with the highest volume of COVID-19 patients in the city – more than 1,500 clinically suspected or confirmed positive cases so far.
And so they relied on an invaluable resource that many consider an identifying trait of Einstein — support from everyone from the front office to front-line workers; collaboration and collegiality between departments – to add critical beds and ventilators practically overnight.
In a recent 72-hour period, two spaces in the surgical suite typically used for pre- and post-operative care were converted into critical care units for COVID patients on ventilators, adding 21 beds.
From Anesthesia to Ventilation
And equally as important, anesthesia machines were repurposed to enable appropriate ventilator support for these critically ill patients, increasing the number of available ventilators by almost 50 percent – adding 21 to the original 50. Einstein is in the vanguard of hospitals making this conversion in the face of equipment shortages.
The job was complicated and the work was intense. A negative air machine was purchased and ducts were installed to provide negative air pressure in the rooms, so that virus particles in the air could be sucked out. A nurses’ station with positive air flow was created in an enclosed space.
Contractors and in-house employees put up walls and added barriers and lighting. They worked throughout the day and night. They started on a Wednesday, constructing and modifying and deep cleaning. And patients were moved in on a Saturday.
“We were proactive and we knew we had no choice but to do this expansion,” says Rohit Gulati, MD, Executive Vice President and Chief Medical Officer, whose leadership was lauded by the other key players in the transformation: Mark Kaplan, MD, Chairman of The Division of Trauma, Surgical Critical Care and Acute Care Surgery, and Richard Fine, MD, Chairperson of Anesthesiology.
“Dr. Kaplan and his team of trauma surgeons and surgical residents and interns stepped up to make this happen and provided the excellent care to the patients in the ICU,” Dr. Gulati says.
Complex Adjustments to Machines
Repurposing the anesthesia machines was equally challenging. “It’s an amazing challenge to get these anesthesia machines to mimic the work of a complex ICU ventilator,” says Dr. Fine, who helped direct the conversion along with Mansoor Husain, MD, Clinical Director of Anesthesiology, and Tejas Parikh, MD, Clinical Coordinator of Anesthesiology.
“It’s not a simple conversion. They were never intended for long-term use,” Dr. Fine says.
“We had to learn how to change the functions of the machines to address complex issues that were unique to the COVID 19 virus. There are many different air filter and air flow modes to begin with and COVID patients are particularly difficult. They follow no rules of ventilation we’ve ever seen before – it’s different from patient to patient and hour to hour,” Dr. Fine says. They were assisted by guidelines from the American Society of Anesthesiologists and the American Patient Safety Foundation.
Drs. Gulati, Fine and Kaplan cited many others in the hospital in the success of this rapid transformation, including President and Chief Operating Officer Dixie James and Vice President of Healthcare Services Maureen Jordan.
Dr. Gulati also noted the “real heroes,” the front-line employees from nurses to carpenters to respiratory therapists, as well as Terry Vizak, Director of Respiration Therapy; Craig Sieving, Vice President of Facilities; and Emergency Department physician Ryan Overberger, DO.
“We deployed our staff in nontraditional positions and everyone stepped up to the plate,” says Radi Zaki, MD, Interim Chair of the Department of Surgery and Co-Chair of the organ transplant team. “We formed a tight community and helped each other out with a very good outcome.”
For instance, certified registered nurse anesthetists, who usually provide anesthesia support to patients, received additional training and teamed one-to-one with a surgical intensive care unit nurse, under the leadership of chief nurse anesthetists Anne Rodman and Stephanie Pryor.
“Without the collaboration between surgical intensive care nursing, led by Michale Golasa, Director of Clinical Nursing, and Chief Nursing Officer Gina Marone, the process would not have succeeded. We could not be more proud of what they’ve accomplished,” Dr. Fine says.
A New Use for Baby Monitors
The creativity unleashed by COVID-19 also led to a moment of levity – which is in short supply in this grim environment – when the problem of monitoring patients in a step-down unit arose. The rooms are not alarmed the way traditional critical care rooms are and it was decided that baby monitors would work to allow nurses to observe patients on ventilators from the nurse’s station.
That meant a scramble to buy baby monitors, and the assistance of Dr. Kaplan’s adult children. They purchased monitors at Bed, Bath & Beyond, Walmart and elsewhere. Dr. Kaplan’s wife, Susan, arranged to turn them over.
“I met my wife at the Willow Grove Mall because there was parking there,” Dr. Kaplan says. “We met and she gave them to me. I came back carrying them and people weren’t sure if I was working in maternity or I’d had a psychotic break,” he says with a laugh.
But, to everyone’s relief and gratitude, “they worked.”
Photo: Dr. Kaplan shows the new COVID-19 unit, transformed from a former post-surgical unit.