Safety, Surge, and Strain: Where and When Does Risk Occur in Critical Care?

The article discusses the impact of the COVID-19 pandemic on critical care and the relationship between surge conditions and mortality. A study conducted in the Netherlands found that as COVID-19 hospitalizations increased, the number of patients in the ICU with non-COVID conditions decreased. There was also a small but clear relationship between surge conditions and mortality, indicating the strain on healthcare resources and its impact on patient safety. The study highlights the need to consider the risks of deferred surgeries and the quality of care provided during high caseloads. ICUs worldwide are facing strain due to capacity and staffing issues, which has highlighted the risk of mortality. However, there is limited understanding of the factors that impact patient outcomes. There is a need for better data and research definitions to define ICU care beyond just location. Using markers of patient acuity and interventions such as pressors and mechanical ventilation can help assess the risk. It is important to capture changes in staffing and training levels. Data lakes with patient data could be used to identify safety risks, but they are often not coupled with temporal data or hospital information. Healthcare should follow the aviation industry's example and agree to submit essential information to a third party to shape our understanding of the relationship between strain and safety. At the bedside, proactive evaluation of risk mitigation can be done through tests of change, such as new staffing models and smart technology. A surge index could be developed to predict and compare strain across hospitals. ICU care should focus on preventing adverse outcomes associated with infections and pressure [Extracted from the article]