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ESAIC Newsletter Issue #82: Reflections from a Critical Care and Theater Clinical Director

Dr Alvaro Arcocha MD. Hospital Universitari de Bellvitge (Barcelona, Spain).

aarcocha@bellvitgehospital.cat

I am writing this while part of my mind is still designing possible plans for future situations we might face in the course of this pandemic. But please, firstly, let me introduce the hospital where I work and my role there. I am an anaesthesiologist who is in charge of the management of critical care units and theatre rooms in a third -level hospital serving a population of 1.8 million in Barcelona (Spain). Hospital Universitari de Bellvitge is, or more accurately was, a 740 bed-institution with 34 beds in medical ICU, 10 in the coronary care unit and 24 in postoperative and surgical ICU.

If I may, I would like to stop for one minute here and go back to the previous 4 weeks, in order to explain the transformation that we have experienced as a hospital for offering a quick response to the SARS-CoV-2 epidemic.

At the end of February, with increasing cases in Italy and foreseeing an increase in Spain too, a crisis committee was created in the hospital. Soon some priorities became apparent, such as the need to increase ICU bed capacity for COVID-19 patients but also for patients without the viral infection. At the beginning of March, plans had to be implemented by cancelling elective surgery lists and outpatient clinics, implementing telemedicine clinics where possible, and creating 40 new ICU beds. Ventilators were transferred from the operating theatre rooms and new monitors and beds were acquired rapidly. We also recruited last year-grade nursing students, retired doctors and nurses that could face the increasing demand in the emergency department, respiratory wards and ICU.

With all that, the hospital was ready to admit 108 COVID-19 patients requiring critical care and 20 for non-COVID patients. Anaesthesiologists, intensivists and cardiologists rescheduled their shift patterns to take care of the sickest patients in ICUs. The anaesthesia and critical care department were responsible for 70 critical care beds while ensuring anaesthesia care for any emergency surgical procedures.

Our vision and mission were shared with two other centres of the area (Hospital de Igualada and Hospital de Martorell) by supporting them with managerial and organisational proposals which reinforced the inter-hospital network. In this tireless marathon, we also assembled other imaginative spaces like the congress hall (Hospital Fira Salut) and the Sports Stadium. Acquisition of protective equipment and the establishment of psychological support systems for staff and relatives enabled a low rate of infection among professionals. In the middle of April, we cautiously re-started cancer surgery.

I would like to stop the description of the current situation, trying to imagine what the future would bring us and how we respond to it, especially next winter when a second hit of the pandemic is a real possibility. Thus, we are planning to maintain certain structures that enabled the response to this crisis. Although we are facing less overall hospital admissions, our ICUs are under considerable strain with ongoing new admissions. We also plan to increase the non-deferable hospital activity while the number of patients in ICUs continue to fall. Our professionals feel proud of the work they are providing but they are also enduring a high emotional burden. We will be deploying a gradual process of going back to routine from a clinical and human resource perspective with normalisation of working schedules.

Coronavirus has strengthened us as a hospital team, but also relations with our patients and the community we serve. Lessons that today cannot be learned will be clear in next months: professionalism, humility, and clear ethical principles. Because medicine today, more than ever, is a humanitarian science.

 

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