Abstract
SummaryBackgroundIntensive care units (ICUs) experienced a surge in patient cases during the COVID-19 pandemic. Demand was managed by redeploying healthcare workers (HCWs) and restructuring facilities. The rate of ICU admissions has subsided in many regions, with the redeployed workforce and facilities returning to usual functions. Previous literature has focused on the escalation of ICUs, limited research exists on de-escalation. This study aimed to identify the supportive and operational strategies used for the flexible de-escalation of ICUs in the context of COVID-19.MethodsThe systematic review was developed by searching eight databases in April and November 2021. Papers discussing the return of redeployed staff and facilities and the training, wellbeing, and operational strategies were included. Excluded papers were non-English and unrelated to ICU de-escalation. Quality was assessed using the mixed methods appraisal tool (MMAT) and authority, accuracy, coverage, objectivity, date, and significance (AACODS) checklist, findings were developed using narrative synthesis and thematic analysis.FindingsFifteen papers were included from six countries covering wellbeing and training themes encompassing; time off, psychological follow-up, gratitude, identification of training needs, missed training catch-up, and continuation of ICU and disaster management training. Operational themes included management of rotas, retainment of staff, division of ICU facilities, leadership changes, traffic light systems, and preparation for re-expansion.InterpretationThe review provided an overview of the landscape of de-escalation strategies that have taken place in six countries. Limited empirical evidence was available that evaluated the effectiveness of such strategies. Empirical and evaluative research from a larger array of countries is needed to be able to make global recommendations on ICU de-escalation practices.
Highlights
Just over 200 million cases and 4.4 million deaths had been reported worldwide due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by August 2021.1 COVID-19 has placed an unprecedented demand on intensive care units (ICUs) around the world
The most relevant training strategy in relation to preparation for future surges of COVID-19 was to continue with ICU and disaster preparedness training and practices
The reasons for exclusion were due to the content being irrelevant to ICU de-escalation and staff redeployment or were not in English
Summary
Just over 200 million cases and 4.4 million deaths had been reported worldwide due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by August 2021.1 COVID-19 has placed an unprecedented demand on intensive care units (ICUs) around the world. The limited pool of ICU qualified healthcare workers (HCWs) made it difficult to source new staff to fulfil the intensive care responsibilities.[4]. Most healthcare settings have had to make do with the limited resources available in the time-sensitive conditions to restructure existing facilities and redeploy the existing healthcare workforce to the ICUs. Many settings expanded ICU facilities by developing temporary ICUs in operating theatres that were not in use as elective procedures had been cancelled, by converting paediatric ICUs (PICU) into adult ICUs as the infection had not affected children as severely as adults, or by outsourcing patients to private healthcare providers.[5−8] To fulfil the workforce requirements, medical professionals were redeployed from the areas of care that were not in high demand www.thelancet.com Vol 44 Month February, 2022
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