Empty theatres, drafting physios: the plan to quadruple NSW’s COVID-19 ICU capacity

Entire hospital wards and operating theatres will be commandeered for critically ill COVID-19 patients, and physiotherapists called in to help care for them, as NSW intensive care units execute plans to quadruple their capacity and brace for an influx of cases.

There are 35 COVID-19 patients in NSW ICUs – 16 on ventilators – as the state’s total number of confirmed cases rose to 2032. Health authorities warn these numbers will balloon.

The COVID Red ICU at RPA Hospital. Credit:Kate Aubusson

NSW Premier Gladys Berejiklian says the state’s 874-bed ICU capacity would be doubled or quadrupled before the pandemic has abated.

Finding almost 900 or 1800 more beds is no mean feat, considering Australia’s total ICU bed count is 2200.

ICUs will spill into other areas of the hospital, including operating theatres, day surgery, emergency department and recovery bays, coronary care and high-dependency units, say health authorities working on the state’s pandemic planning.

Decommissioned hospitals or unfinished facilities nearing the end of construction could be transformed into makeshift ICUs.

Patients who would have been cared for in these units might be moved to private hospitals or clinics in the community.

If they’re overwhelmed we could see field hospitals on showgrounds and now-empty sporting facilities.

New guidelines by Australia’s peak intensive care organisation make provisions for a “minimal impact” pandemic to a full-blown “overwhelming impact” that assumes ICUs can’t cope with the numbers of COVID-19 patients needing ventilators.

In an “overwhelming” scenario, critically ill patients would be “treated in areas without pre-existing critical care infrastructure”, the Australian and New Zealand Intensive Care Society’s (ANZICS) COVID-19 guidelines say.



Under such a scenario, medical teams would make carefully calibrated, yet agonising, decisions about discharging patients they would have otherwise kept in ICU, and choose not to admit others.

But bed count was too crude a measure for ICU capacity, senior staff specialist of intensive care, ANZICS board member and co-author of the guidelines, Dr Mark Nicholls, said. "What good are beds in a coronavirus pandemic without enough ventilators or specialised healthcare teams to use them?"

Earlier this month NSW Health deputy director Susan Pearce said she had ordered 500 more of the life-saving breathing machines, and expected to order more.

RPA has 57 ventilators and another 40 on order. Its intensivists expect they will need all 97 at once.

Anaesthesia machines can be converted into ventilators, and veterinarians are taking inventory of their human-grade ventilators in case they are needed.

Dr Nicholls said the true measure of ICU capacity would come down to staffing.

“We have an extremely specialised workforce that everyday looks after very sick patients and they are our most valuable resource,” Dr Nicholls said.

"Then we have about 100,000 healthcare workers in NSW. We have this huge workforce that we can call on to help us look after COVID patients,” Dr Nicholls said.

The “COVID-19 teams” – staff in close contact with coronavirus patients – would have a segregated roster from “clean teams” working in the rest of the hospital.

With non-essential elective surgeries cancelled, anaesthetists and anaesthesia nurses can be re-deployed to ICUs.

With many of the same skill sets as their intensive care colleagues, these anaesthesia teams will be particularly crucial, forming “resuscitationists” and “intubation teams”, the ANZICS guidelines say.

Instead of the current 1:1 critical care nurse to patient ratio, ICUs would move to a mixed-team model, where the most senior and experienced ICU intensivists and and nurses would manage less experienced healthcare workers who are equipped with some level of critical care training.

Hospitals have already begun identifying nurses trained to care for critical patients, including those on desk duties or in university jobs, paediatric ICUs or recently retired.

Ward nurses and physiotherapists and pharmacists would be called in to work alongside trainee intensive care and anaesthesia doctors.

Social workers would look after the families isolated from their loved ones in ICU and junior medical and nursing staff with little or no ICU training could take over paperwork and inventory duties.

The COVID teams would undergo temperature checks at the beginning of each shift and any ICU staff at risk of severe complications if they were to contract the virus would be re-assigned. That goes for anyone with chronic respiratory or immuno-compromised conditions and pregnant staff.

It was absolutely vital that this healthcare workforce stays healthy, Dr Nicholls said. Losing one person to contamination or infection could knock-out an entire team to 14 days quarantine.



There will need to be a suite of initiatives to support the families of these healthcare workers, including child minding and caring for elderly relatives. Staff who can’t go home will need to be put up in accommodation.

“It will be very difficult … We don’t know what approach is the best approach,” he said.

“But I think we’ll surprise ourselves. I think we can do this really well. We have a world-class health system with fantastic nurses and physicians and facilities. We have the capacity to get very organised and cope,'’ he said.

But none of this matters if the Australian community can’t collectively work to flatten the curve, said Professor Stephen Duckett, the Grattan Institute’s head of health economics.

“If we get a doubling of case numbers every five days then doubling ICU capacity buys us five days,” he said.

“Even if we quadruple ICU capacity it will only be enough if we can bend the curve. The principle strategy must be slowing the spread of the virus."

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