COVID-19 Update from Dr. Smith: 5/08/20

Each day during the COVID-19 crisis, Dr. Craig Smith, Chair of the Department of Surgery, sends an update to faculty and staff about pandemic response and priorities. Stay up to date with us.

Dear Colleagues,

Today the CUIMC bed map shows increasing numbers of vacancies in the 3rd floor ORICUs, and the ratio of reds (Covid+) to greens and blues is visibly decreasing.  The bed map is a highly detailed and instantly understandable image of bed capacity in all of Milstein, created by Hochman et al. When the image is quantitated, one of our persisting challenges is clear.  CUIMC is carrying 40-45% of ventilated ICU patients for all of the NYP system, and our volume is declining more slowly than elsewhere.  This is good news, viewed as testimony to the quality of care delivered by our ICU teams.  That view is getting around. I’m told that our ICU team receives a few requests each day from insiders wanting to transfer ventilated Covid family and friends from all over the place to CUIMC. The downside is that we are making slow progress emptying the 3rd floor ORICUs, which account for almost one-third of our peak OR capacity. The Trach Team has converted almost half of our patients from endotracheal tubes to tracheostomies, making it easier to manage them safely and wean them gradually in less intense settings. NYP is hopeful that NY State will quickly approve an increase in bed complement at Silvercrest, which will improve capacity for in-system transfers of such patients when appropriate. NYP is also working on a number of other transfer options.

With ORICUs fresh in mind, I’ve just watched a remarkable video prepared by our Director of Clinical Perfusion & Anesthesia Support Services that compresses into 10 minutes the massive logistic effort behind conversion of ORs to ICUs.  That conversion is perhaps the most extraordinary part of increasing ICU capacity from 422 to 970 that NYP accomplished in only 19 days.  Mentally run this video in reverse to get a sense what has to be done to reopen the involved ORs.  Depending on your specific role in the Department, you might wonder who these people are.  The core of the group are perfusionists, a title derived from their primary perfusion-management task operating heart-lung machines for open heart surgery.  That role has expanded remarkably over recent years to include many critical support roles outside the open heart ORs, such as bedside ECMO management, and cell-saver management in all ORs.  The group also includes those who provide technical support to our anesthesiologists.  At baseline, this exceptional group illustrates how many individuals contribute to the complicated miracles occuring in operating rooms for which surgeons get to enjoy the credit.  In this crisis, they’re another example of the motivation, adaptability, and sheer stamina of all the people who’ve brought us to this point in the return to new-normal. 

Stirling Moss, the internationally celebrated race driver, was known for risk-taking that many thought crossed the line to recklessness.  When asked about that, he said “I’m a racer, not a driver.”  It isn’t the drivers who’ve accomplished this much, this fast.

Craig R. Smith, MD
Chair, Department of Surgery
Surgeon-in-Chief, NYP/CUIMC

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