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The number of ventilators is the most common limiting factor for the United States

• To function appropriately, intensive care units (ICUs) need space (ICU beds), staff (nurses, physicians, and respiratory therapists), and stuff (ventilators). For hospitals and communities to effectively respond to the anticipated surge in the critical care needs for COVID-19 patients, the balance between space, staff, and stuff (i.e., resources) needs to be maximized.
• Strategies for creating space capacity include repurposing existing space and expanding telemedicine to allow ICU physicians to advise non-ICU physicians in community hospitals.
• Strategies for creating staff capacity include using physician extenders to provide critical care under the supervision of ICU doctors and expanding staff through recruitment from outside organizations.
• Strategies for creating stuff capacity include reusing personal protective equipment and regional sharing of available ventilators.
• The overall number of patients who can be cared for is limited by whichever resource is most limited. In the majority of estimates for the United States, ventilators are the limiting factor. In a few instances, doctors are the limiting factor, but in no case is the number of nurses, respiratory therapists, or beds the limiting factor.

The coronavirus disease 2019 (COVID-19) virus is creating unprecedented stresses on hospital and critical care systems. Hospitals, health care systems, states, and regions urgently need to assess their resources, identify potential bottlenecks, and create strategies for increasing critical care surge capacity, which refers to the resources needed to care for the sickest patients with the novel coronavirus.

In this report, the authors present a list of strategies for creating critical care surge capacity and estimate the number of patients accommodated, given the number of available critical care doctors and nurses, respiratory therapists, ventilators, and hospital beds. They also document the development of a user-friendly, Microsoft Excel–based tool that allows decisionmakers at all levels — hospitals, health care systems, states, regions — to estimate current critical care capacity and rapidly explore strategies for increasing it.

The strategies are organized into two tiers. Tier 1 includes contingency capacity strategies: adaptations to medical care spaces, staffing constraints, and supply shortages in a way that can increase capacities without significant impact on medical care delivery. Tier 2 includes crisis capacity strategies: changes that likely will have significant impact on routine care delivery and operations.

• Chapter One

  Background

• Chapter Two

  Essential Components of Critical Care Capacity

• Chapter Three

  Strategies to Create Critical Care Surge Capacity

• Chapter Four

  Assessing Critical Care Capacity Created by Various Surge Strategies

• Chapter Five

  Next Steps and Policy Recommendations

• Appendix

  Research Methods