INTRODUCTION: Our hospital experienced a surge in ICU capacity during the COVID-19 pandemic and adopted a tiered provider staffing model We hypothesized that ICUs staffed with a tiered model would result in similar patient outcomes as ICUs staffed with a traditional intensivist model METHODS: The study was conducted at a tertiary care center with 52 ICU beds staffed with a 24/7 intensivist coverage model During the pandemic, ICU capacity was doubled and ICUs with COVID-19 patients were staffed by either an intensivist or by a non-intensivist under the direction of an intensivist using a tiered system We included adult ICU patients with ARDS and suspected or confirmed COVID-19 between March and May of 2020 We collected demographics, COVID-19 and ARDS treatments, and outcomes of interest in traditionally staffed ICUs vs ICUs staffed with a tiered model The primary outcome was inpatient mortality All outcomes were censored at day 28 We used Student's t-test, Wilcoxon Rank-Sum, Fisher's Exact, and Chi-Square for statistical analysis RESULTS: A total of 138 patients were included: 66 admitted to traditionally staffed ICUs and 52 to tiered staffing ICUs The mean age was 67±12 1 years, 63% were male, and the mean SOFA score on admission was 7 5±2 9 Baseline characteristics were similar between groups More patients in the tiered staffing ICUs received convalescent plasma (14 vs 3%, p=0 05) and azithromycin (41 vs 23%, p=0 05) There was no difference in other COVID-19 treatments, including corticosteroids, tocilizumab, and hydroxychloroquine ARDS treatments were similar in traditionally staffed ICUs vs tiered staffing model ICUs, including daily median tidal volumes (6 2 vs 6 2mL/kg, p=0 95), median daily fluid balance (159 vs 92mL, p=0 54), and use of prone ventilation (58 vs 65%, p=0 45) There was no difference in inpatient mortality between groups (50 vs 42%, p=0 46) Successful extubation rates were similar between groups (36 vs 40%, p=0 71) We also found no difference in ventilator-free, ICU-free, vasopressor-free, and dialysis-free days between groups CONCLUSIONS: Patient outcomes were similar using a traditional vs a tiered ICU staffing model during a pandemic Our analysis is limited by its observational nature and confounded by other healthcare team staffing models
The effect of a tiered staffing model on outcomes for patients with ARDS during the COVID pandemic