Charles Bruen, MD
Senior Staff Physician
Regions Hospital
Saint Paul, Minnesota
Disclosure information not submitted.
Aaron Burnett, MD
Senior Staff Physician, Emergency Medicine
HealthPartners, United States
Disclosure information not submitted.
Jessie Nelson, MD
Senior Staff Physician, Emergency Medicine
HealthPartners, United States
Disclosure information not submitted.
Joe Walter, MD
Senior Staff Physician, Emergency Medicine
HealthPartners, United States
Disclosure information not submitted.
Ben Willenbring, MD
Senior Staff Physician, Emergency Medicine
HealthPartners, United States
Disclosure information not submitted.
Jacqueline Hegarty, MD
Senior Staff Physician, Emergency Medicine
HealthPartners, United States
Disclosure information not submitted.
Michael Zwank, MD
Senior Staff Physician, Emergency Medicine
HealthPartners, United States
Disclosure information not submitted.
Josh Salzman
Director Medical and Speciality Care
Regions Hospital, United States
Disclosure information not submitted.
David Niccum, MD
Department Chair, Critical Care
HealthPartners, United States
Disclosure information not submitted.
Kurt Isenberger, MD
Emergency Department Medical Director
HealthPartners, United States
Disclosure information not submitted.
Title: Emergency Medicine Physicians in the ICU during the 2020 winter COVID-19 surge
Introduction: Emergency Medicine (EM) physicians have a skill set complementary to intensivists with a larger overall workforce. We describe the experience of deploying EM physicians to provide 20 hrs/day of support to a medical intensive care unit (MICU) in a tertiary academic integrated health system urban hospital during the 2020 winter COVID-19 surge.
Description: In November 2020 our MICU experienced a surge in daily census from approximately 20 to over 50 patients, 66% of whom were COVID-19 positive with respiratory failure. In response, our hospital deployed emergency physicians from the ED to the MICU full time (EM-ICU). All EM-ICU were board certified in EM and had completed an advanced fellowship (various subspecialties including toxicology, ultrasound, patient safety), and were faculty of an EM residency program. They had an average of 10 (3-16) years post-residency clinical experience. EM-ICU deployed to the ED as soon as a MICU admit was identified based on the initiation of intubation/mechanical ventilation or vasopressors. The EM-ICU facilitated the transition to an in-patient bed much earlier in the clinical course than is typical at our institution. Procedural tasks including central line, arterial line, dialysis catheter, and tube thoracostomy were primarily completed by the EM-ICU. Intubations in the ICU were routinely performed by the EM-ICU freeing up anesthesia personnel. EM-ICU also served as team leads for in-hospital codes and rapid response activations.
Discussion: The addition of an EM-ICU attending to an intensivist-led ICU team increased the efficiency of care delivery in our MICU during the winter 2020 COVID-19 surge. Supplementing an intensivist with a second attending physician experienced in advanced airway management, post intubation sedation and cardiac arrest resuscitation who is procedurally independent allowed intensivists to focus on tasks more unique to the MICU setting including assessment for extubation, bronchoscopy and ventilator management. Given the primary respiratory pathology associated with COVID-19, freeing up intensivists to perform time intensive advanced ventilation strategies was a major benefit of having EM-ICU. Our experience suggests that physicians board certified in EM can play an important supporting role as part of an intensivist-led ICU team.