Frederique Pinto, MD
Acute Care Surgery Fellow
Baystate Medical Center
Springfield, Massachusetts
Disclosure information not submitted.
Timothy Putnam, BS, MS
Research Associate
Baystate Medical Center/Univ of Massachusetts Medical School
Springfield, Massachusetts, United States
Disclosure information not submitted.
Sandy Roh, MD
Chief Resident, General Surgery
Baystate Health/University of Massachusetts Medical School, Massachusetts, United States
Disclosure information not submitted.
Celene Boyce, ANP
Nurse Practitioner, Surgical-Trauma ICU
Baystate Medical Center/Univ of Massachusetts Medical School, United States
Disclosure information not submitted.
Evan Minkin, ACNP, MSN
Nurse Practitioner, Surgical-Trauma ICU
Baystate Medical Center, United States
Disclosure information not submitted.
Kimberly Starr, ANP
Nurse Practitioner, Surgical-Trauma ICU
Baystate Medical Center/Univ of Massachusetts Medical School, United States
Disclosure information not submitted.
Kayla Slessler, CCRN
Critical Care RN, Surgical-Trauma ICU
Baystate Medical Center/Univ of Massachusetts Medical School, United States
Disclosure information not submitted.
Kristina Grochowski, RN, MSN
Trauma Program Manager
Baystate Medical Center/Univ of Massachusetts Medical School, United States
Disclosure information not submitted.
Reginald Alouidor, MD
Trauma Medical Director
Baystate Medical Center, United States
Disclosure information not submitted.
Tovy Kamine, MD
Medical Director, Emergency General Surgery
Baystate Health Inc, United States
Disclosure information not submitted.
Edward Kelly, MD
Division Chief, Trauma and Acute Care Surgery
Baystate Medical Center/Univ of Massachusetts Medical School, United States
Disclosure information not submitted.
Kristina Kramer, MD
Associate Medical Director, Surgical-Trauma ICU
Baystate Medical Center/Univ of Massachusetts Medical School, United States
Disclosure information not submitted.
Gabriel Ryb, MD
Trauma & Acute Care Surgery Attending
Baystate Medical Center/Univ of Massachusetts Medical School, United States
Disclosure information not submitted.
Eleanor Winston, MD
Chief, Surgical Quality
Baystate Medical Center/Univ of Massachusetts Medical School, United States
Disclosure information not submitted.
Tyler Putnam, II, MD, FACS, FCCM
Medical Director, Surgical-Trauma ICU
Baystate Health/University of Massachusetts Medical School
Springfield, Massachusetts, United States
Disclosure information not submitted.
Title: Surgical-Trauma Critical Care during the COVID-19 Era: Clinical, Economic and Operational Challenges
Introduction: Surgical-trauma ICUs (STICU) during the pandemic era face unique challenges due to significant changes in resource availability, allocation, and COVID driven operational constraints. Our hypothesis is that continued analysis of these challenges is required to maintain quality trauma ICU care.
Methods: Detailed factors unique to surgical-trauma critical care were analyzed at a Level 1 trauma center that is also the regional treatment center for the COVID-19 pandemic. Specific objective clinical, economic and organizational factors were assessed over a 30-month period prior to and including the current pandemic era (Jan 2019-Jun 2021).
Results: A 30-month comparative data analysis was completed that included 2 COVID surge periods and 3 STICU geographical moves. COVID hospital/ICU pts surged between 3/20-5/20 and 12/20-2/21 (peak COVID hospital/ICU-422/52 pts); STICU census decreased 80% during surge 1, 20% during surge 2; Acute Care Surgery division wRVU production varied during surge periods (surge 1,surge 2); Trauma (-12%,-17%),Surg Crit Care (-8%,-8%), Emerg Gen Surgery (-40%,+16%). wRVUs now normalized. Trauma Cat 1/Cat 2 activations decreased 33%/23% during surge 1; 23%/52% during surge 2. 58,192 total medical center operative cases during period, 1939/month; surge 1 cases minus 38%/month (lowest month: minus 58%), surge 2 minus 0.7%/month. CAUTI, CLABSI, pressure wounds all increased in new STICU during pandemic; only pressure wounds correlated with surges. Additional STICU challenges identified during the analysis period leading to care delivery challenges include ICU design deficiencies, communication/daily goal tool utilization (< 50% goal), RN-MD communication/collaboration (workgroups established), RN trauma specific training deficits and RN management challenges (new 0.5 mile office separation, new STICU specific RN leader need).
Conclusion: The COVID-19 pandemic presents unique multidisciplinary critical care challenges. The STICU at our Level 1 trauma center continues to maintain quality care and successfully address challenges from significant changes in clinical, economic, and organizational factors. Subjective analysis and intervention is ongoing to address trauma training, multidisciplinary team morale, critical care RN-MD collaboration and ICU design improvements.