How to turn a heart unit into an intensive care unit
Unconventional ICU spaces necessary to care for critically ill patients during third wave
Long before the third wave of the pandemic had begun, Hamilton Health Sciences (HHS) was thinking about ways to create additional space for critically ill patients if it was needed.
And that’s a good thing – because when the latest surge of COVID patients arrived, every last intensive care bed (ICU) was full and the hospital needed to get creative to set up additional unconventional ICU spaces.
Since the Heart Investigation Unit (HIU) at HHS’ Hamilton General Hospital is regularly staffed with critical care nurses, the HIU was prepared to convert part of the unit to an ICU when the time came.
Planning began in collaboration with the ICUs, burn trauma unit, critical care unit, and post-anesthesia care unit. The group considered everything from how to register, admit and triage patients to staff education, equipment and supplies.
“A host of stakeholders all came together to collaborate,” says Kathleen Badeau, clinical manager of the HIU. “We thought, ‘what do we need to make sure we have the right skill set, equipment, supplies, set-up, and everything in place so that we can care for these critical patients?’”
The teams set up the physical footprint, prepared their staff, and documented the process in case it was needed again in the future.
Vast equipment needs
Setting up an ICU in a space that wasn’t originally intended for that purpose involved many teams, including logistics, engineering, cleaning services and porters.
“There were vast equipment needs,” says Badeau. “Any supplies you can think of that would be needed in an ICU set-up, we mirrored in our temporary ICU.”
There was extensive work required to set up the rooms where non-COVID ICU patients would be cared for, while COVID-19 patients filled up the regular ICUs. This included setting up critical care beds, a review of ECG monitors and ventilators, and equipment like pumps and appropriate cables support mechanical breathing.
The teams organized a mock set-up of the rooms to ensure they would have all the appropriate equipment when a patient was admitted.
They officially starting caring for ICU patients on April 13.
There is currently room for 15 ICU patients in the HIU. This is part of the 43% increase in ICU beds across HHS.
Almost half of the HIU staff members were redeployed to work in the ICU section of the unit.
In partnership with HHS educators, an education plan was put in place to refresh staff on mechanical ventilation, review medical directives and e-documentation, encourage job shadowing, and organize tabletop exercises. In collaboration with the ICU East, the HIU spent buddied shifts in the ICU proper for knowledge sharing.
The team has a quick meeting each morning, and is supported by Badeau and a leadership team who are committed to ensuring staff have what they need to do their work.
“It was really important to us that we created a culture of respect and a culture where anyone who came to us felt welcome and supported,” she says.
The HIU team welcomed new respiratory therapists, ICU physicians, and nurses to their area.
“Because we knew there were new faces in our footprint, we created a welcome package with information about the lunch room and lockers. We wanted the new staff to feel comfortable and incorporate themselves into our team,” she says. “It’s most important to me as a manager that staff have what they need and are being heard.”
Cardiac care is still ongoing
Hamilton General Hospital is a regional cardiac centre, providing advanced care for patients across South Central Ontario.
The HIU is one of the largest of its kind in Canada. The team performs a variety of procedures to diagnose and, in some cases, help treat heart conditions.
Badeau and Dr. Madhu Natarajan, director of the HIU, worked together to plan how to run the HIU and temporary ICU side-by-side at the same time.
Due to the pandemic, HIU patient volumes have been reduced by 50% which has resulted in longer than usual waitlists, but the HIU continues to provide care for patients in need of emergency cardiac procedures.
“The situation is very fluid and we hope to resume normal activity in the near future,” says Natarajan.
Thank you to staff
Like many areas of the organization, staff are being redeployed where they are needed most.
“It is commendable how the entire HIU team has rallied to support the urgent need for ICU expansion to manage very sick patients from both within and outside the region,” says Natarajan.
The work is hard in this new model, but the staff have risen to the occasion.
“I’m so very proud of the work of this highly skilled team during this ICU surge,” says Badeau. “It’s very admirable. I’m very grateful for them.”
Hear from HIU staff
Kathy Badeau, Clinical Manager, Heart Investigation Unit, Hamilton General Hospital
“Careful planning and preparation of the Heart Investigation Unit (HIU) for ICU surge began early on in the pandemic. The dedication and support of all team members, champions, physician partners, and leaders that worked tirelessly to ready the unit for the required equipment and supplies; development of staffing models and schedules; education and training to enhance our nursing teams’ critical care skill set…is truly inspiring! It is with much gratitude that I work alongside the team as we care for our patients, families, and each other during this very challenging time.”
Brian Dang, Medical Radiation Technologist – Cardiac and Vascular program, Heart Investigation Unit/Electrophysiology Unit/Vascular OR, Hamilton General Hospital
“In the HIU, we usually run 3-4 labs a day but dropped down to 2. We are still very busy. Any available staff have been sent to assist elsewhere such as Diagnostic Imaging ER. Within the Vascular Operating Room, we are seeing much younger, very sick patients requiring ECMO support. Every discipline within the healthcare system is coming together in all capacities to help save these people. We need everyone to do their part and stay safe so we can come out of this as quickly as possible.”
Elise Moore, Registered Nurse, Heart Investigation Unit, Hamilton General Hospital
“One of the most important lessons I have learned during this whole pandemic is just how interconnected we all are. Especially thinking about the volume of cases we are seeing during this third wave. The little decisions we make every day are how we take care of each other right now. We need to continue to advocate for those whose work continues to put them in positions of risk and vulnerability. Anything you can do to reduce your exposure is a step in the right direction.”
Caitlin Panton, Senior Medical Radiation Technologist for the Cardiac and Vascular, Heart Investigation Unit/Electrophysiology Unit/Vascular OR, Hamilton General Hospital
“The teamwork throughout every single health care profession is exemplary. We are working tirelessly to help your loved ones. However, everyone needs to continue to do their part so we can all get through this. We truly are ALL in this together.”