Most Recent Update
Article for hospital leaders with possible scenarios to prepare for
Future Pandemic Staffing Strategy
Estimates of hospitalized patients requiring critical care and mechanical ventilation: The U.S. Department of Health and Human Services (HHS) estimated in 2005 that 865,000 U.S. residents would be hospitalized during a moderate pandemic (as in the 1957 and 1968 influenza pandemics) and 9.9 million during a severe pandemic (as in the 1918 influenza pandemic).11 A recent AHA estimate for COVID-19 projected that 4.8 million patients would be hospitalized, 1.9 million of these would be admitted to the ICU, and 960,000 would require ventilatory support.4, 12
Staffing to care for critically ill patients: As large numbers of critically ill patients are admitted to ICU, step-down, and other expansion beds, it must be determined who will care for them. Having an adequate supply of beds and equipment is not enough. Based on AHA 2015 data, there are 28,808 privileged and 19,996 full-time equivalent intensivists in the United States; however, 48% of acute care hospitals have no intensivists.3 An intensivist is a board-certified physician who provides special care for critically ill patients. Also known as a critical care physician, the intensivist has advanced training and experience in treating this complex type of patient. Based on our analysis, the intensivist deficit will be significant. Additionally, there are an estimated 34,000 critical care advanced practice providers (APPs) available to provide care for critically ill patients.13 Other physicians (e.g., pulmonologists, surgeons, anesthesiologists, etc) may be pressed into service as outpatient clinics and elective surgery are suspended. In addition to intensivists, all other ICU staff (advanced practice providers, nurses, pharmacists, respiratory therapists, etc) will also be in short supply. Without these key members of the ICU team, critical care cannot be adequately delivered. Moreover, an indeterminate number of experienced ICU staff may become ill, further straining the system as need and capacity surge.
At the crisis levels forecast above, we estimate that the shortage of ICU physicians, advanced practice providers, respiratory therapists, and nurses trained in mechanical ventilation would limit the maximum number of ventilated patients to approximately 135,000, well within the supply of currently available equipment.10 Therefore, priority should focus on expanding the number of trained professionals, for both the near and longer term, who will be needed to both mechanically ventilate patients with COVID-19 as well as to care for other critically ill patients who would normally require ICU care.
Augmenting critical care staffing: To deal with this issue, SCCM encourages hospitals to adopt a tiered staffing strategy in pandemic situations such as COVID-19 (Figure 2). Hospitals with telemedicine capacity may also use the technology to connect with expert resources at other locations.
