Converting a Cath Lab to COVID-19 ICU: A NY Hospital Explains How
The biggest challenge “was facing the unknown and getting comfortable with uncertainty,” said Anna Bortnick.
In an effort to provide a “blueprint” to other hospitals needing additional space to treat patients with COVID-19, one New York-based team published an outline of how they converted their cath labs to intensive care unit (ICU) space and back again.
“By the time the surge was spreading across the Midwest, with reports of parking garages being converted to field hospitals, California running out of ICU beds, and a second wave spreading across Europe, it felt absolutely imperative that we write [this paper],” senior author Anna Bortnick, MD, PhD, MSc (Jack D. Weiler Hospital, Bronx, NY), told TCTMD in an email.
The main message she hopes readers will take away from their experience is that “we have to impose structure on the chaos of this pandemic,” she said. “Focus on values and the priorities become clear. Then, navigate a path to accomplish the priorities. Cath Labs have the components of the infrastructure that we need to combat this crisis—space, staff, and clinical expertise—but it’s the people that have the heart to do it.”
We wrote about coverting our Cath Labs to COVID-19 ICUs. A blueprint for other health systems running out of ICU beds. @InvasiveCardiol @DLBHATTMD @MAlvarezVillela @tom_boucher_med @azeemlatib 👉🏼https://t.co/J2ueRz0FGH— Anna Bortnick MD, PhD, MS (@anna_bortnick) December 23, 2020
Bortnick and her team managed to convert much of their space into dedicated COVID-19 intensive care and step-down units all while maintaining their STEMI treatment capacity. The biggest challenge for them, she said, “was not building or taking down walls. It was facing the unknown and getting comfortable with uncertainty.” On the other hand, “one of the biggest surprises was how easily staff fulfilled their new roles in the COVID-19 Cath Lab ICU. People drew on previous experience and lifted others. Everyone was learning and pulling together. Another surprise was how well the COVID-19 Cath Lab ICUs integrated into the larger hospital critical care effort alongside critical care medicine and heart failure colleagues.”
Their paper, published online December 22, 2020, in the Journal of Invasive Cardiology, highlights several key concepts to making this transition work.
First, they explain, they prioritized key objectives to guide their approach: “to provide intensive care for COVID-19 patients, maintain guideline-based care for STEMI, protect staff health, conserve material resources, conduct scientific research, and educate trainees.”
Next, they identified interventional cardiologists as being “well suited for treatment of critically ill COVID-19 patients due to familiarity with shock” and organized their staff into teams alongside those specializing in heart failure.
Before opening these new ICUs, in-person rounds with critical care specialists were part of their protocol as was review of online materials from the Society of Critical Care Medicine. They also embraced an interdisciplinary approach that included physicians, physician assistants, nurses, and technicians. In order to ease communication among the team and streamline patient management, they used a structured rounding checklist and posted vital signs, laboratory values, and ventilator parameters on patient doors. Telemedicine was also adopted to efficiently consult on certain patients across specialties.
Lastly, “centralized, system-wide communication of clinical and research protocols, and conferencing with colleagues, locally to internationally, was paramount in providing contemporary management for COVID-19,” they write.
Because interventional fellows were transitioned into several atypical positions during the pandemic, Bortnick said one of their main concerns as mentors was “trainee well-being; avoiding exhaustion and illness by platooning them, rotating from acute and less acute care, on and off the front line. Staying healthy in this pandemic is in itself a public service.
Patients survived and recovered from COVID-19 because of the skill of our fellows and nurses. Anna Bortnick
“Interventional fellows are among the most advanced trainees in the hospital,” she continued. “They are extremely well equipped to manage complex and unstable patients because they have years of internal medicine and general cardiology experience. Fellows can naturally step into a leadership role in the unit setting because managing critical care is complimentary to their procedural skillset and pulls it all together. Patients survived and recovered from COVID-19 because of the skill of our fellows and nurses.”
Additionally, bolstering the mental and physical health of all staff was paramount to their success this year, Bortnick said. “I think it’s a great idea to embed psychiatrists, psychologists, or social workers in with ED and COVID-19 ICU teams. Montefiore has done this in various ways. It is physically demanding to wear full PPE for extended periods of time. Breaks, hydration, and skin care are necessary to keep a high level of performance.”
It’s one thing for hospital staff to be more comfortable dealing with death and morbidity than the average person, “but before the pandemic, they were not accustomed to having an infectious disease threatening their safety daily,” she continued. “Having emotional support built right into the unit team environment is a strength and probably a model worth adopting beyond the pandemic.”
Villela MA, Boucher T, Terre J, et al. Surge-in-place: Conversion of a cardiac catheterization laboratory into a COVID-19 intensive care unit and back again. J Invasive Cardiol. 2020;Epub ahead of print.
- Bortnick reports no relevant conflicts of interest.