LIFE IN THE HICU: PREPARING A HOSPITALIST TO MANAGE A COVID-19 ICU

Background: In March 2020, with a precipitous surge of cases within a three-week period, the hospital infrastructure crumbled–COVID-19 impacted New York with unparalleled intensity. The unrelenting volume of patients coupled with the prolonged intensive care unit (ICU) stays of COVID patients led to a rapid expansion from two medical ICUs at our two academic centers to thirteen ICUs at the height of the pandemic in April. The ICU volume quickly became overwhelming for our intensivists to safely handle and thus, a core group of hospitalists volunteered to join the intensivists in managing COVID patients in the ICU setting.

Purpose: The purpose of the hospitalist ICU experience was to train a hospitalist with no critical care experience to become a Hospitalist ICU (HICU) attending for critically ill COVID-19 patients.

Description: A rapid assimilation of information was necessary as there was less than two weeks from proof of concept to a hospitalist entering a COVID ICU. In collaboration with the ICU staff, a virtual crash course was provided on the basics of critical care, ventilator management, and vasopressor titration through the Microsoft Teams platform. In addition, newly created COVID-19 ICU primers detailing ventilator management strategies, COVID-specific medication protocols, and general critical care management strategies were disseminated to the hospitalists. Hospitalists also utilized SHM’s critical care for the hospitalist modules and other online resources to supplement the structured virtual course. The ICU structure was designed to have a layered support system. After formal ICU rounds, the hospitalist had separate ventilator rounds with an ICU fellow or attending, during which the ventilator settings for each patient were reviewed and optimized. During these rounds, the hospitalists also discussed other urgent matters relating to patient care. Furthermore, hospitalists had twenty-four hour access to an in-house ICU fellow or attending, the respiratory care team, and an electronic ICU. This structure enabled the ongoing development of the hospitalist’s critical care skills and ensured optimal patient care.

Conclusions: A core group of six hospitalists successfully led two COVID-19 HICU units for 8 weeks until the COVID-19 ICU census decreased enough to dissolve the rotation. With strategic preparation and an interdisciplinary approach, a hospitalist can successfully manage a COVID-19 HICU.