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| REVIEW ARTICLE |
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| Year : 2020 | Volume
: 4
| Issue : 5 | Page : 3-5 |
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Successful Rapid Deployment of Intensive Care Services in Response to the COVID-19 Pandemic: A Case Study in Saudi Arabia
Awad Al-Omari1, Abbas Al Mutair2, Alyaa Elhazmi3, Khalid Naif Alobeiwi4, Amin K Khattab5, Ali A Rabaan6
1 Research Center, Dr. Sulaiman Al Habib Medical Group; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
2 Research Center, Almoosa Specialist Hospital, Al-Ahsa, Saudi Arabia, School of Nursing, Wollongong University, Australia
3 Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
4 Ministry of Health, Madinah, Saudi Arabia
5 Ohoud Hospital, Ministry of Health, Madinah, Saudi Arabia
6 Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| Date of Submission | 03-Sep-2020 |
| Date of Decision | 20-Sep-2020 |
| Date of Acceptance | 28-Sep-2020 |
| Date of Web Publication | 7-Dec-2020 |
Correspondence Address:
Abbas Al Mutair
Almoosa Specialist Hospital, Dahran St, Alfaisal District, Al-Ahsa, P.O.Box: 5098, Eastern Province l
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/sccj.sccj_44_20
The coronavirus disease-2019 (COVID-19) pandemic has triggered a significant demand to support the most affected areas of severe and acute cases inside Saudi Arabia including the application of telemedicine. During the pandemic, the intensive care unit (ICU) staff from the largest private health-care sector were deployed to support the national critical care services and overcome the shortage of ICU staff in the greatest affected regions in Saudi Arabia. This study aims to describe the administrative actions taken to manage and treat the severe cases of COVID-19 that required ICU services and the deployment of the ICU services provided by private health-care providers to the most affected areas. The ICU staff have been rapidly deployed from the largest private health-care provider in the Middle East, from Riyadh province in the Central Region of Saudi Arabia for Madinah province in the Western region. Within 10 weeks, a total of 309 patients have received ICU and tele-ICU services. Approximately, 208 ICU staff, including intensivists, nurses, respiratory therapists, clinical nutritionists, and clinical pharmacists, have been providing ICU services 24 h a day, 7 days a week. The tele-ICU command center has provided valuable support, including the expert clinical guidance and consultation from the expert ICU consultants, utilizing audio-visual telecommunication networks, and governance of quality of the ICU among other many functions. With an average of 11.82% mortality rate, no accidental re-intubation reported cases, a zero re-intubation and re-admission rate within 48 h, this approach can be successfully followed and implemented in the future for risk and crisis management at local and international levels.
Keywords: COVID-19, deployment of intensive care services, intensive care unit
How to cite this article:
Al-Omari A, Al Mutair A, Elhazmi A, Alobeiwi KN, Khattab AK, Rabaan AA. Successful Rapid Deployment of Intensive Care Services in Response to the COVID-19 Pandemic: A Case Study in Saudi Arabia. Saudi Crit Care J 2020;4, Suppl S1:3-5 |
How to cite this URL:
Al-Omari A, Al Mutair A, Elhazmi A, Alobeiwi KN, Khattab AK, Rabaan AA. Successful Rapid Deployment of Intensive Care Services in Response to the COVID-19 Pandemic: A Case Study in Saudi Arabia. Saudi Crit Care J [serial online] 2020 [cited 2023 Jun 4];4, Suppl S1:3-5. Available from: https://www.sccj-sa.org/text.asp?2020/4/5/3/302582 |
| Introduction | |  |
The mortality rates of coronavirus disease 2019 (COVID-19) vary between 0.7% to 10%.[1] The total number of deaths caused by COVID-19 has so far exceeded the combined deaths caused by the Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS).[2] COVID-19 has an estimated case fatality of 3%–4%, while MERS-CoV and SARS fatality rate were 34% and 11%, respectively.[2] Out of the total confirmed COVID-19 cases, it is anticipated that 10%–15% require invasive mechanical ventilation, and therefore, intensive care unit (ICU) services.[3]
As most countries globally have already been hit hard by COVID-19, health-care systems are attempting to increase the supply of health-care workers to respond to the surge in demand to provide acute treatments for those who need it.[4] COVID-19 has caused significant strain on ICUs worldwide including Saudi Arabia, which is expected to persist for months or beyond. This poses a risk for severe and augmented disruption in care and requires proactive planning for ICU staff augmentation.[4] Studies have shown that 5%–16% of COVID-19 cases require an ICU admission.[3],[5],[6]
The COVID-19 pandemic denotes a unique challenge to intensive care services. During an epidemic, the major problem revolves around preparing ICU units and the health-care workers for the expected surge in caseload, which may be complicated by workforce challenges with potential difficulty in maintaining standard staffing ratios of expert qualified personnel.[7] Adding to the increase in need of a larger number of qualified front liners, as the number of those available has reduced due to the high infection rate among them, which is in fact higher than that of their patients not only based on the expectation of their ages and their exposure to higher viral load, but also to decreased immune systems due to the high level of stress of overtaxed front-line health care workers.[8] This study aimed to describe the ICU capacity and strategies in Saudi Arabia to respond to the predicted increased demand associated with the COVID-19 pandemic and a case study of the deployment of the ICU services from the private healthcare providers to the most affected areas with COVID-19.
| Command Team and Staffing | | |
A dedicated task force team from Dr. Sulaiman Al Habib Medical Group was created on May 23, 2020, with the task of rapid deployment of ICU staff to increase the surge capacity in a local hospital in the Madinah region by adding 50 fully staffed and equipped ICU beds. The taskforce was guided by firstly assessing the required personnel and equipment. The task force worked hand in hand with the administration of the local hospital to prepare the extension of their ICU in the regular ward, the essential changes in the infrastructure of those extensions, the necessary adjustments from other services in the facility including support services, such as pharmacy and the requisite additional ICU equipment such as health monitors and ventilators. The deployed personnel included a total of 208 ICU staff members, including 6 ICU consultants, 10 specialists, 10 residents, 2 clinical nutritionists, 2 clinical pharmacists, 20 respiratory therapists, and 158 senior critical care nurses. A response plan of the taskforce was designed to treat critically-ill COVID-19 patients in the ICU and to train and orient all of the staff who were expected to work in ICU. The ICU, with 50 beds capacity, was temporarily located in the hospital’s empty areas. Both the original and the extended ICU were gradually activated over a period of 5 days to forecast the daily needs and treat critically ill COVID-19 patients. Another challenge faced was concerning HMG’s original ICU staffing because it was expected not only to keep their original capacity but to be prepared to expand later on to battle the increase in demand if there was a surge in Riyadh.
Staffing was strategized according to the Ministry of Health and CBAHI regulations for ICUs, including a 1:1 nurse to patient ratio. A three-shift-day system was developed with a team handling every 8 h. A total of 208 staff was appropriately rotated throughout the shifts. The shifts were designed to blend experienced staff with the less experienced ones together in one shift to maintain sustainability. Open communication strategies were maintained during the deployment period through daily meetings and E-mail communications to present work progress and achievements. The open communication strategies played an important role in relaying any changes in the protocols, procedures, and national and international guidelines.
| Education and Training during COVID-19 | | |
The initial purpose of the training during the pandemic was to train additional staff to provide critical care to patients in the ICU.[8] Infection control principles and training on procedures for ICU and non-ICU staff were also crucial during the COVID-19 pandemic. This included the proper use of personal protective equipment and an assessment of competence in their use.[8],[9] During the SARS pandemic, the risk of staff infection was associated with a lack of training and infection control procedures.[10] Along with infection control procedures and principles, ICU and non-ICU staff should be instructed on how to connect, operate, and supervise mechanical ventilation as up to 15% of the total COVID-19 patients need an ICU bed and mechanical ventilation.[3],[5],[6],[11]
Training in advance is always crucial as it is difficult to conduct training during a pandemic.[11] However, during the pandemic, hospitals offered refresher training programs on infection control policies and procedures and critical care medicine, especially tailored for COVID-19 patients.[8] The emphasis of training is important as the improper use of PPE increases the staff risks of infection to themselves and their families along with simulation training on aerosol-generating procedures with a high risk of COVID-19 dissemination to ensure competency with the needed precautions.[8],[9] To ensure harmonious interaction and operation of the ICU in the local hospital, the interaction with the ICU with the other services in the hospital as with the emergency department, wards, pharmacy, and physiotherapy, was emphasized with rigorous training. Priority refreshers and practice of protocols such as rapid response team and code activation were done. In addition, for a successful implementation, proper staffing and scheduling are vital to avoid overstressing health-care workers.[9] Hospitals administration may also consider assimilating experienced employees with the less experienced ones in one team during a pandemic.[9] This may provide intermittent reassurance to the less experienced ICU staff. As the standard of care in ICU, the experienced consultants will supervise and guide the junior staff and will overlook the care delivered to the patients.
| Tele-Intensive Care Units | | |
One of the biggest obstacles during the treatment of COVID-19 patients is infection transmission among patients and health-care providers as well as staff shortage. Tele-ICU utilization during the COVID-19 pandemic would be a very effective method for facing such challenges as Tele-ICU services can be utilized to monitor patients’ status from multiple locations.[12] Tele-ICU can also reduce contact with patients, which will consecutively minimize the infection hazards in a hospital.[13]
Tele-ICU has been found to improve the quality of health care being provided by increasing data flow between health-care workers in the ICU and command center and by covering the shortage of intensivists.[14] Previous literature supports the fact that tele-ICU can reduce healthcare workers’ exposure to infection as well as provide and share medical data rapidly between professionals.[15] In addition, tele-ICU can make sure that patients are receiving their pharmaceutical care optimally.[16] Tele-ICU can be very practical as staff can do the work thought interactive video calls to check on their patients and communicate with them.[14] A recent study from Saudi Arabia has found that tele-ICU has helped in significantly reducing the mortality rate, length of stay, readmission rate, hospital-acquired pressure ulcer rate, and discharge against medical advice rate.[17]
| Conclusion | | |
In this study, we reviewed the collaborative administrative actions implemented to successfully manage and treat severe COVID-19 cases that needed ICU services, along with effectively deploying ICU services provided by private health-care providers to the most affected regions. The review has also described the staff planning of the command center team during the disposition and strategies followed, such as open communication between ICU staff. All staff was actively involved and trained using online applications and platforms together with continued quality assurance monitoring. In addition, the Tele-ICU program at Dr. Sulaiman Al Habib Medical group was utilized effectively during the deployment period. This review has demonstrated how the use of technology along with continuous education and training of the staff and open communications have helped to significantly maintain the ICU parameters. The early success of the ICU deployment services from the governmental and nongovernmental departments is vital in controlling and managing the spread of COVID-19 through precise allocation of resources to stabilize the public’s livelihood.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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