It was around 7 p.m. on Saturday when I received a call from the chief medical officer (CMO) at my facility asking my team to go above and beyond for nine COVID-19 patients, all of whom needed immediate support.
Six patients from the general medical floors required rapid intubation and critical care, while three patients in the emergency department (ED) also needed immediate intubation.
The ICU was overflowing, and multiple intensivists were ill. Everyone was working relentlessly to save patients’ lives and provide the best possible care. The CMO said to me, “Are you up to the challenge of managing all of these intubated patients until space and reinforcements can come?”
Recognizing the magnitude of the situation, I took a deep breath and said, “I will do everything I can to protect these patients and support the hospital.”
As the Emergency Department Director at one of the busiest facilities in New Jersey, it was my responsibility to rally the team and make sure we helped patients pull through.
Along with the help of my team of amazing doctors, nurses, advanced practice providers, scribes and a rockstar respiratory therapist, we all made it through the night.
During that same shift, when things were under control, we took a moment to devise a plan to care for critically ill patients. Around 2 a.m., with the help of scribes Matt Bertolini and Sam Bucek, we designed a rounding list and hand-off forms. Repurposing the ICU admission order set, we made sure every patient received the appropriate care.
Four of our ED colleagues immediately stepped up to become part of our newly formed ED intensivist team. Dr. Leah Roberts was the first to volunteer, quickly followed by Dr. Jessica Maye, Dr. Ken Minett, and my righthand partner, Dr. Chris Crean. Together, we quickly established a rounding schedule and a sign-out process for our new “ED ICU.” For the next five days, we managed anywhere between four to nine critically ill patients in the ED.
As an emergency physician, I have extensive experience treating patients under challenging circumstances, thinking quickly and developing innovative solutions to support care delivery. This experience required me to draw from the many years of treating patients in the ED.
It also made me extremely grateful for my colleagues who are tireless in their commitment to patients and working together as a team. I want to thank everyone, from Dr. Douglas Smith and Trish Hennelly, who rallied Envision reinforcements, to Javeria Hassan and Kelsey Wolff. They bolstered efforts to become critical care documentation experts.
Managing this many critically ill patients for a prolonged period has required us to utilize resources in different ways. For example, we are now providing virtual health consultations department-wide to help with the delivery of timely patient care. Megan Allen, Director of Clinical Services, led the heavy lift for the virtual health platform, along with Albert Chou, one of our scribes, and the Telemedicine Team, led by David Inniss, Provider Digital Engagement Platform Director.
Despite the high number of patients, I can proudly say that every patient received the best possible care, and each of them is alive today.
This herculean team effort truly represents the saying, "It takes a village." In this instance, it all happened at lightning speed. The realized success is 100 percent due to all the team members performing at their best and rising to the challenge.
Other hospitals within the health system have now requested Envision’s model. The “ED ICU” was a solution developed in a time of need. The innovative model has become operable across hospitals.
The teamwork, innovation, sharing of best practices makes me proud to be part of Envision – a medical group that is committed to patients and making a meaningful difference in the delivery of quality care.