Amit Uppal (
David M. Silvestri is an emergency medicine physician and senior director of care transitions and access, Office of Ambulatory Care, NYC Health + Hospitals.
Health Aff (Millwood). 2020 Aug;39(8):1443-1449. doi: 10.1377/hlthaff.2020.00901. Epub 2020 Jun 11.
New York City has emerged as the global epicenter for the coronavirus disease 2019 (COVID-19) pandemic. The city's public health system, New York City Health + Hospitals, has been key to the city's response because its vulnerable patient population is disproportionately affected by the disease. As the number of cases rose in the city, NYC Health + Hospitals carried out plans to greatly expand critical care capacity. Primary intensive care unit (ICU) spaces were identified and upgraded as needed, and new ICU spaces were created in emergency departments, procedural areas, and other inpatient units. Patients were transferred between hospitals to reduce strain. Critical care staffing was supplemented by temporary recruits, volunteers, and Department of Defense medical personnel. Supplies needed to deliver critical care were monitored closely and replenished to prevent interruptions. An emergency department action team was formed to ensure that the experience of front-line providers was informing network-level decisions. The steps taken by NYC Health + Hospitals greatly expanded its capacity to provide critical care during an unprecedented surge of COVID-19 cases in NYC. These steps, along with lessons learned, could inform preparations for other health systems during a primary or secondary surge of cases.
纽约市已成为 2019 年冠状病毒病（COVID-19）大流行的全球中心。该市的公共卫生系统——纽约市健康与医院公司（New York City Health + Hospitals），是该市应对疫情的关键，因为其脆弱的患者群体受到该疾病的不成比例的影响。随着该市病例数的增加，NYC 健康与医院公司实施了计划，以大幅扩大重症监护能力。确定并根据需要升级主要重症监护病房（ICU）空间，并在急诊科、程序区和其他住院病房中创建新的 ICU 空间。患者在医院之间转移以减轻压力。通过临时招聘、志愿者和国防部医务人员来补充重症监护人员。密切监测提供重症监护所需的用品，并进行补充，以防止供应中断。成立了一个急诊科行动小组，以确保一线医护人员的经验为网络层面的决策提供信息。纽约市健康与医院公司采取的这些措施极大地扩大了其在纽约市 COVID-19 病例空前激增期间提供重症监护的能力。这些措施以及吸取的经验教训，可以为其他卫生系统在原发性或继发性病例激增期间的准备工作提供参考。
