Abstract
To accommodate the unprecedented demand for critical care beds during the first surge
of the coronavirus disease 2019 (COVID-19) pandemic in the United Kingdom, hospitals
had to adapt, restructure, and collaborate to provide the best possible care for the
pediatric and adult populations. This single-center experience outlines the considerations
our hospital took into account when planning for this restructure and the steps taken
to ensure a successful execution of the task. Cross-specialty collaboration between
the pediatric and adult critical care teams adopted a unique approach to care for
only critically ill COVID-19 positive adult patients in the pediatric intensive care
unit (PICU), transferring out critically unwell children at an early stage before
the adult intensive care unit (AICU) became overwhelmed (nonhybrid model). This was
designed to be in a staggered fashion, before allowing the AICU to overflow. This
approach enabled the adult critical care team to support pediatric colleagues in learning
the nuances of looking after critically ill adults prior to the service being saturated
by the predicted supersurge. The success of the operation hinged on two things. First,
PICU staff continuing to work in a familiar environment with their usual clinical
team and second, the gradual and controlled admission of adult patients into PICU
before the peak in demand for critical care beds. This design helped protect staff
morale and build confidence in their new clinical role. The overall case fatality
of invasively ventilated patients with COVID-19 in our hospital during the first surge
was 32%, which is lower than the global average of 45%. This serves as evidence that
this nonhybrid model is safe and sustainable.
Keywords
COVID-19 - restructure - surge capacity - critical care - pandemic - coronavirus
