The Role of a Statewide Critical Care Coordination Center in the Coronavirus Disease 2019 Pandemic-and Beyond

Abstract

Objective: Public health emergencies, like the coronavirus disease 2019 pandemic, can cause unprecedented demand for critical care services. We describe statewide implementation of a critical care coordination center designed to optimize ICU utilization. To describe a centralized critical care coordination center designed to ensure appropriate intensive care resource allocation.

Design: A descriptive case series of consecutive critically ill adult patients.

Setting: ICUs, emergency departments, freestanding medical facilities in the state of Maryland and adjacent states, serving a population of over 6,045,000 across a land area of 9,776 sq mi (25,314 km2).

Patients: Adults requiring intensive care.

Interventions: Consultation with a critical care physician and emergency medical services clinician.

Measurements and main results: Number of consults, number of patient movements to higher levels of critical care, and number of extracorporeal membrane oxygenation referrals for both patients with and without coronavirus disease 2019. Over a 6-month period, critical care coordination center provided 1,006 critical care consultations and directed 578 patient transfers for 58 hospitals in the state of Maryland and adjoining region. Extracorporeal membrane oxygenation referrals were requested for 58 patients. Four-hundred twenty-eight patients (42.5%) were managed with consultation only and did not require transfer.

Conclusions: Critical care coordination center, staffed 24/7 by a critical care physician and emergency medical service clinician, may improve critical care resource use and patient flow. This serves as a model for a tiered regionalized system to ensure that the demand for critical care services may be met during a pandemic and beyond.