Reengineering Workflow in the Intensive Care Units during COVID-19 Pandemic

Coronavirus disease-2019 (COVID-19) has led to a pandemic that pushed many intensive care units (ICUs) worldwide beyond their limits. To maintain efficient critical care services and to protect critical care staff, reengineering the ICU workflow became a necessity. The care of COVID-19 patients occurred in designated ICUs. High-efficiency particulate air filters were installed in rooms that did not have negative pressure. Non-ICU wards were used for care of critically ill patients. Handover between physicians, multidisciplinary rounds, and entry into the ICU were changed to avoid large gathering inside the units. Tiered staffing approach was used to maintain an adequate nurse-to-patient ratio. The care of non-COVID-19 patients took place in clean ICUs by a dedicated medical team to avoid cross contamination. As visitation was prohibited during the pandemic, communication with families of patients was done via advanced telecommunication methods such as videoconferencing. To protect ICU staff, appropriate donning and doffing of personal protective equipment were monitored and corrected by qualified personnel. Reuse or extended use of such equipment was carried out due to supply shortage.