During the post-Thanksgiving COVID surge in southern California, the intensive care units (ICUs) in community hospitals have been especially hard hit by an influx of critically ill COVID patients. On January 8, Christopher Ortiz, MD, PhD, became the first of our critical care specialists to help lighten the load on Martin Luther King Jr. Community Hospital (MLKCH) by covering shifts in its overstressed ICU.
“I think we’ve all seen and read about what’s going on in the community, at Antelope Valley and MLK,” said Maxime Cannesson, MD, PhD, our department chair. “They’ve been hit disproportionately compared to us. We understood they have a problem.”
“We realized actually that we had workforce available from the ICU to help,” Dr. Cannesson said. Though the UCLA ICUs are extremely busy, our intensivists have routinely spent days working in the regular operating rooms too, he explained. Thus, our department has the capacity to staff the OR with other faculty and staff anesthesiologists, allowing the intensivists to attend at these community hospitals, especially when the surgical volume was down due to COVID.
Our department has a long-standing relationship with MLKCH, delivering anesthesia services in the operating rooms and obstetric services. Our faculty member Hamid Nourmand, MD, serves as chief of the anesthesiology program and Medical Director of Perioperative Services at MLKCH, and a number of other faculty members and nurse anesthetists rotate on clinical duty. But until January, the MLKCH ICU had been staffed exclusively with pulmonary/critical care intensivists, who were struggling to meet the clinical demand.
In December, Dr. Cannesson contacted the Chief Medical Officer, John Fisher, MD, MBA, to offer the additional help with ICU coverage.
“He said yes, if you can, that would be great!” Dr. Cannesson recalled. Within two weeks, they worked out the details. Since Dr. Ortiz already had privileges at the hospital, there were no roadblocks to keep him from starting work right away.
MLKCH 100% above capacity with COVID patients
Dr. Fisher gave Grand Rounds to our department on January 20, and explained that in recent weeks the hospital census at MLKCH has exceeded 200 patients though the hospital has only 130 licensed beds. There have been more than 35 patients doubled up in an ICU built to accommodate 20.
“The nurses, physicians, and respiratory therapists have been overwhelmed,” Dr. Fisher said, making the additional support from our department welcome indeed. The majority of MLKCH admissions have been COVID patients, both in the ICU and regular wards.
“The caseload increased to the point where two attendings are required during daytime hours to staff the ICU,” Dr. Ortiz said. “We serve as that second daytime attending to allow their staff a few days off from what have been near-daily ICU shifts.” Since the census has outgrown the physical ICU space on the first floor of the hospital, all ICU-level patients have been moved to a “makeshift” ICU on the fifth floor. Before that move, overflow ICU patients were housed in the PACU and emergency department.
High-risk population in local community
“It certainly has been challenging! Learning a new EMR, getting acquainted with new personnel and equipment – all of course took a few days to get used to,” Dr. Ortiz said. “The acuity is very high. On my first day I had 15 patients, all of whom had COVID and were intubated, and several of whom were on hemodialysis.”
The ICU patient population is predominately Latinx, Dr. Ortiz noted, “a reflection of the local area population, but also a stark reminder of the unique susceptibility of this community to COVID infection. Many of the older patients suffer from the sequelae of chronic conditions including diabetes, kidney disease, and obesity.”
Antelope Valley Hospital, a public hospital and Level II trauma center with 420 beds, located 63 miles north in Lancaster, has also seen its ICU and emergency department overrun with COVID patients since December. Though our department had no prior working relationship with Antelope Valley, our offer of help was eagerly accepted there too.
Joseph Meltzer, MD, the medical director of the UCLA Cardiothoracic ICU, has been the second intensivist to work at MLKCH and the first to cover the ICU at Antelope Valley. He described the unit as extremely busy, with a very high-acuity patient load.
In addition to Drs. Ortiz and Meltzer, other UCLA intensivists will be helping with the clinical care at MLKCH and Antelope Valley, including Vadim Gudzenko, MD, the director of our Critical Care Fellowship Program, David Boldt, MD, Laleh Jalilian, MD, and Michael Lin, MD. Other intensivists among our faculty have volunteered to pick up additional ICU shifts at UCLA to cover those going to outside ICUs as needed. Three physicians in our Critical Care Division are intensivists with emergency medicine training who also contribute to ICU coverage at Antelope Valley: Sara Crager, MD, Allison Ferreira, MD, and George Lim, MD.
“It gives me great pride to be able to help our community where it needs it the most,” Dr. Cannesson said. “I think it’s the right thing to do. It makes what we do extremely meaningful.”