How Yale New Haven increased ICU capacity by 75% amid pandemic

Yale New Haven (Conn.) Hospital increased its intensive care capacity 75 percent through the implementation of an alternative care model that converted general patient care units and perioperative spaces to ICUs and therefore required more critical care nurses.

The alternative care model is detailed in The American Organization for Nursing Leadership's Voice of Nursing Leadership September publication. The article is written by Jeannette Bronsord, DNP, RN, executive director of surgical services; Kelly Poskus, RN, director of nursing-neuroscience services; and Laura Jansen, RN, clinical program director of nursing resource operations center, all at Yale New Haven Hospital.

In mid-March, scenario planning indicated the 1,541-bed hospital would need 500 more beds in anticipation of a COVID-19 surge. To meet this need, YNHH shifted to team nursing, an alternate staffing model that allows clinicians with varying skill levels to collaborate and provide patient-centered nursing care. Because COVID-19 care requires 1-to-1 nurse-to-patient staffing, leaders decided to expand the ICU nurse's ability to care for a larger number of patients. Using this method, the hospital's adult ICU capacity grew from 193 beds to a potential 338 beds. 

Six takeaways: 

1. The model minimized personal protective equipment use and maximized support to individuals directly caring for patients.

2. Ambulatory nurses, care associates, technicians and other staff from procedural and ambulatory locations were retrained for new inpatient assignments. 

3. Nurses were stratified into groups based on how quickly they could be safely retrained and redeployed. A color-coded system was developed to expedite appropriate nurse placement.

4. The centralized nursing education department developed a transition-to-practice refresher for both ICU and medical-surgical nurses. Content about airway management, medications and dysrhythmias were offered via video classes, and specific skills were reviewed in person.

5. Four- to six-member proning teams were trained and then available 24/7 to ICU nurses. When not directly involved with proning, the team functioned as part of a support team. The team's activities included bathing, patient transport, bringing supplies and equipment to patient rooms, and running off-unit errands.

6. Increasing the workforce amid the pandemic required the ability to leverage the strengths and abilities of all team members; an agile and flexible nursing workforce; ongoing communication and engagement to foster newly formed partnerships; and an increased sense of teamwork among all specialties and departments that allow for quick identification of issues and rapid responses.

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