From Agility to Zoom Meetings: Uniting Diverse Teams to Achieve Clinical Excellence During Winter 2020/2021 COVID-19 Surge

BACKGROUND INFORMATION: Since Fall 2020, increased critical care demands from COVID-19 related surges found Augusta University Health System (AUHS) requiring additional staffed ICU and medical-surgical beds to accommodate patient care needs. In response, the Perianesthesia department developed a team staffing model and converted PACU and day surgery space to accommodate the additional patient volume. As the region's only level-1 trauma center, the accommodation of the additional capacity had to include maintaining capacity for urgent, emergent, and medically necessary OR cases. OBJECTIVES OF PROJECT: Project objective was to develop and recruit qualified nurses to a new staffing model to expand to 24/7 operations maintaining safe, high-quality care to a mixed population of ICU and medical/surgical level patients while maintaining OR operations for medical necessity. PROCESS OF IMPLEMENTATION: A Perioperative Services Surge Plan was developed to balance the needs of the hospital overflow and operative volume. All Perianesthesia bed space was converted to virtual beds that could accommodate ICU, floor, or operative care. An assessment of Perianesthesia and Operative RNs was made to evaluate skill mix and availability to work overnight and weekend hours. Fast track PACU to ICU and medical-surgical skills competency-based orientation was developed which included staff orientation, resources, and documentation skill sets. A unit assessment was completed and supplies and processes to support ICU and floor level of care were obtained and initiated. A schedule was created to support all operations and to provide clear role assignments. STATEMENT OF SUCCESSFUL PRACTICE: 20 ICU beds and 16 medical/surgical beds were successfully opened while maintaining 30-40 OR cases each day. PACU was limited to 11 functional bays for Phase I recovery. Day Surgery was limited to 13 bays to preop and Phase 2 patients. IMPLICATIONS FOR ADVANCING THE PRACTICE OF PERIANESTHESIA NURSING: The Perianesthesia elements of the Perioperative Services surge plan, team staffing model and clearly defined unit workflows promoted optimization of resources and capacity to provide high quality care to overflow ICU and medical surgical volume while maintaining necessary OR operations.