43 COVID Crisis: A Burn Approach

Abstract

IntroductionThe net effect of the COVID-19 pandemic on this northeastern, urban healthcare system during March, April and May 2020 was the redirection of virtually all resources to the care of the affected population. Conversion of the majority of the hospital’s assets, including staff and infrastructure, to COVID care created a large reduction in resources for other clinical problems. The burn service was among those few essential disciplines that continued to receive acutely affected individuals during the crisis. The preservation of the burn center’s ability to continue its mission within the walls of a COVID hospital is the subject of this review.MethodsAll of the hospital’s ICU rooms, including all those on the burn unit, post anesthesia care units, some step-down units, and over 90% of the operating rooms (ORs) converted to COVID care ICUs. These vital actions by hospital administration enabled an increase in ICU beds from 114 to 270. Staff were redeployed to cover the massive influx of critical COVID patients.Burn inpatients during the transition were categorized by severity and age for disposition consideration. Of the 17 inpatients, 4 pediatric patients discharged home and 1 transferred to our associated children’s hospital; 7 adults discharged home, 2 transferred to our associated inpatient psychiatric hospital, 1 to inpatient rehab, and 2 transferred to a neighboring orthopedic hospital converted into an adult acute care hospital.The commitment to keep the burn center operational for both children and adults was facilitated by protecting the burn ICU hydrotherapy room, a large patient care space in the center of the burn ICU. Children, initially admitted and cared for in the hydrotherapy room until stable, transferred to our network Children’s hospital for continued care. Critical adult burns were admitted to the inpatient ICU with the COVID patients, acute burns were housed on the few remaining medical surgical units. Burn care was performed in the patients’ rooms to keep the hydrotherapy room “clean”.ResultsDuring the 3-month period described the burn service admitted and cared for 92 adult and 25 pediatric patients while maintaining a full ICU census. Although 3 admitted burn patients were COVID +, no burn patients housed in the ICU became COVID + during their stay.ConclusionsThe commitment to protect the burn hydrotherapy space for burn triage and care from the top level of administration was critical and notable given the widespread conversion of the subspecialty ICUs and most other patient care areas to COVID care units. Strict adherence to infection prevention guidelines and protection of the hydrotherapy room allowed burn patients to receive timely and appropriate care during a pandemic.