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The first wave of the #covid19 pandemic is subsiding and we are surfacing for a gulp of fresh air, before we dive in again. Some reflections on the ICU/NHS/research (thread)
We coped, just about. There wasn't a lot of wiggle room, but it sort of worked. We have been lucky, that not only the specialty, but also the wider hospital and NHS leadership listened to the warning sounds. Cancelling elective activity and freeing up acute capacity was key.
The quick planning and execution to go to surge capacity was one particular period where everyone involved should be really proud of. Doubling and trebling capacity was never needed in my patch before. The dusty plans only called for 2 weeks of it at most.
In comparison, at @GrangeCritCare we spent 40+ days in surge capacity, and ~3 weeks above 200% capacity. This was never planned properly and posed unique challenges, from location to staffing, kit, supply of consumables and drugs and workflows.
We talked a lot about kit and there were various stages of "kit shortage". Ventilators never been one of them, as we have repurposed everything we could. The biggest shortage was and continues to be staff.
Critical care has been chronically understaffed and underprovided for more than a decade in Wales. The @WCCTN has shown it time and time again, that even in "peacetime" the capacity is not meeting the demand. #COVID19 put us under the spotlight.
That we managed and saved lots of lives, comes down to the sheer determination of ICU and non-ICU staff. Without theatre nurses, ODPs, TAs, anaesthetic colleagues we wouldn't have coped. They were all fantastic. With them we maintained resemblance of normal critical care. THANKS!
@WCCTN has been asked how could we retain some of the expanded ICU capacity in preparation to the second wave and also in general increasing access to critical care. We might have a TOP GUN opportunity here. Recruit and retain.
From the nursing&AHP side, we should aim for 150% staffing of "peacetime" beds. It would give flexibility, better work-life balance and possibly route for promotion. To recruit new nurses in the last 10 years, senior post were slashed. #COVID19 showed that this was a mistake.
The senior critical care nurses with their experience and leadership made critical care safe when we had non-ICU staff redeployed. Many of the more junior nurses stepped up to this plate and they should be recognised, so they have some incentive to do it again and again.
We also need to rapidly expand the ACCP workforce as that career progression route can be attractive for a wide range of staff from different backgrounds. This is the time to get them into the training posts, it will not help us in wave 2-3-4, but certainly will post-#COVID19
From the medical side, we offered opportunity to many non-ICU doctors to see what we do. The feedback is generally favourable. Training numbers increased, which is great, but we should develop a more robust tier of doctors who want to experience ICU. @Drtmr @mbmuthuswamy @mizenpe
The combined ICU/ED/Acute Medicine fellowship posts are incredibly popular and the "conversion rate" is pretty good. We should invest into this as it will give us our future colleagues. I don't see it as "alternative" training route, but as a genuine taster of good critical care.
It appears, that the bigger places were able to flex more, probably as they had more slack in the system, being bigger. For the next wave we should seriously consider if there is value of cohorting #COVID19 patients. This is working in other countries in Europe.
This grand idea might fall down as the bigger centres have more specialist roles as well...nevertheless we should use the lull time to think and model this possible scenario. It might help to retain other essential activity and limit non-COVID19 health damage.
Research is my own little sweetheart and it was great to see the UK critical care community united behind big RCTs and observational studies. Well done to the people behind study design, delivery and analysis. This new disease will only be tackled by science done well!
I do think the UK is leading in that and didn't fall to the siren songs of "experimental" therapies. Please read this from @DogICUma @precordialthump @AndersPerner jamanetwork.com/journals/jama/… which applies even more in the era of #COVID19
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