Mari et al. published 10 requirements to convert a surgical unit into a COVID-19 unit [1]. It differs from transforming operating rooms into COVID-19 intensive care unit (ICU) [2], so that these specific requirements are useful. Such a conversion was experienced in our institution in Paris during late March and April 2020. Although we agree with most of the aforementioned 10 steps, we would outline additional considerations.
Governance is a major concern to provide adequate resources and clinical guidance. To reach both objectives, we developed a videoconferencing crisis management, by associating the institutional administrative and medical boards. This allowed us to create up to 20 post-ICU beds out of 99 surgery beds and 7 ambulatory cancer chemotherapy spaces within 24 hours, while emergency surgical capacities were maintained.
In addition to the dedicated clean path for goods and staff, three independent circuits were organized, to avoid COVID-19 patients crossing paths with chemotherapy and surgery patients. The COVID-19 unit was located on one dedicated floor.
Resource allocation by the administrative board was tailored to the medical definition of patients' profiles eligible for admission: COVID-19 patients who were transferred from an ICU after being extubated for at least 48 hours with a stable respiratory status and requiring less that 10l/min oxygen and patients who were not eligible for the ICU. Manpower included voluntary personnel usually working in wards, operating rooms and recovery room along with anesthesiologists and surgeons. Three nurses and 3 nursing assistants on 12-h shifts for 10 patients were dedicated to this unit. Medical supervision was provided by two anesthesiologists, in charge of the organization of medical shifts, the preparation of documents for nurses and medical teams, defining patients' profiles for admission, and the reception of incoming phone calls from other hospitals prior to the acceptance of a patient's admission.
The administrative board was in charge of managing logistics, non-medical manpower, internal information, and communication and relationships with regional health authorities, especially for obtaining authorizations for bed transfers. This team faced the reported logistical challenges [3] particularly due to worldwide shortages in personal protective equipment (PPE), specific devices requirements for continuous positive pressure (CPAP) devices and oxygen supply and availability of anesthesia ventilators for possible rescue ventilation of patients in case of a transfer to an ICU.
The balance between governmental instructions, resources availability and patients’ care was continuously adjusted, with regard to updated scientific knowledge and pandemic evolution, by at least two weakly videoconferencing sessions: one between anesthesiologists and the other between the administrative and medical boards.
From March 31st to April 16th, 24 COVID-19 patients were admitted; of those, 11 had transferred from an ICU, 1 came from home, and 13 arrived from a medicine or emergency department. Only one patient from a medicine department had to be retransferred to an ICU due to acute respiratory distress syndrome. No patients died.
This experience underlines the pertinence of the 10-step guide of Italian colleagues along with the development of a mixed governance approach involving together the administrative and medical boards and the medical team under anesthesiologists’ supervision. It allowed supportive care of patients presenting with various medical conditions in addition to the viral disease as their admission and discharge decision was a balance between healthcare needs and institutional capacities, constantly re-evaluated.
Ethical approval
No ethical approval was necessary.
Sources of funding
No funding has been required for this work.
Author contribution
Michel Sfez, Alexandre Derichard and Marie-Laure Cittanova-Pansard concieved the study.
Michel Sfez wrote the paper.
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Guarantor
Michel Sfez is the guarantor.
Provenance and peer review
Not Commissioned. Internally reviewed.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
References
- 1.Giulio M., Mari G.M., Crippa J., Casciaro F., Maggioni D. A 10-step guide to convert a surgical unit into a COVID-19 unit during the COVID-19 pandemic. Int. J. Surg. 2020;78:113–114. doi: 10.1016/j.ijsu.2020.04.052. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Alexander W, Peters AW, Chawla KS, Turnbull ZA. Transforming ORs into ICUs N.Engl.J.Med DOI: 10.1056/NEJMc2010853. [DOI] [PMC free article] [PubMed]
- 3.French Ministry of Health Besoins en réanimation et réponse capacitaire. Message d’Alerte Rapide Sanitaire. 2020 [Google Scholar]