Thread by @hastie_md

This weekend, my wife @WomenFacultyMD, is rounding as "ICU Lead" in our hospital's largest #ICU: The 28-bed OR-ICU.

The conversion of operating rooms into an ICU, complete with infrastructure and staffing, was done in one week.

One week.

#COVID19 #Pandemic #NewYorkCity

More on how we did that later. I wanted to highlight the #ICULead role.

It's what we used to call "attending".

But when we expand capacity and everyone moves up a rung, the former ICU attendings become #OversightAttending

@SCCM #TieredStaffing

sccm.org/Blog/March-202…

(Side note: @SCCM 's original #TieredStaffing model somewhat strangely had fully licensed and credentialed #anesthesiologists functioning as fellows rather than as #ICULead.

Why? Have no idea. The society is made up of intensivists from multiple primary specialities...

Of any physician, anesthesiologists--as experts in pulmonary physiology, sedation and analgesia, hemodynamic management, volume management, and team-based care--are perfectly suited to step into the role of #ICULead.

@ASALifeline @AbaPhysicians @CUMCAnesthesia ...

This is not to critique @SCCM.

Rather, to highlight that narrow thinking can lead even smart people to overlook ways to leverage the system.

Our biases can limit us. Now is the time to be open-minded and creative.

Thank you for correcting the model, @SCCM)

How do we prepare an #ICULead?

1) Didactic content, both curated from @SCCM, @accpchest, and developed locally, particularly from my medical intensivist colleagues

sccm.org/SurvivingSepsi…

2) Development of local guidelines and protocols.

...Informed by international publications...

...vetted by ED physicians, ICU physicians, anesthesiologists, ID specialists, pharmacists, nurses, Infection Control & Prevention, and hospital administration.

These guidelines needed to be clear, brief, and easily accessible.

Pro-tip for hospitals: Don't push them out in email blasts which require searching of email and sorting various versions.

Create an easy-to-access website to centralize and organize. Mobile-friendly versions.

3) Interactive sessions, in which knowledge #ICULEads have learned quickly can be put to the test.

What decision would you make with this common problem? Why? Here's another way to think about it?

4) Rounding with ICU teams to learn the structure of the day, format of rounds, how to write notes, and how to bill with professional charges linked to diagnoses.

5) IT support to ensure personnel have appropriate access in the electronic health record.

6) A staffing plan. Flexibility and interchangeability is key. 12-hour shifts, day and night allows integration with other departments.

Because the ICU's have functionally become their own, hospital-wide entity.

The important work is happening across departmental lines.

This is a massive team effort. The outpouring of effort by Julia Sobol, @mpgoldklang and Tess Russell made this happen. Tricia Brentjens mastered the scheduling.

Collaboration with Natalie Yip, Jen Cunningham, and Madhavi Parekh refined our approach.

And one more thing: a new ICU physician role: #RemoteFamilySupport.

This physician who cannot be at the front lines reads the ICU team's notes, confers briefly with the #ICULead or #SecondCall, and then calls each patient's family.

Because remember: NO VISITORS #COVID19

Full credit to @WomenFacultyMD for envisioning this role, defining it, and to Yefim Vilnits for organizing it.

In one day, nearly 60 slots were filled, which will support three teams for nearly 20 days.

Even if you cannot be at the front lines because of age or health or risk factors, you can still have an important in helping the ICU team be more effective.

And this is one lesson from the #pandemic: we work best when we work together.