Table 5

Clinical care delivery in seven repurposed PICUs to care for critically ill adults

HospitalsSt Mary’s HospitalRoyal Brompton HospitalRoyal London HospitalAlder Hey Children’s HospitalRoyal Manchester Children’s HospitalKing’s College HospitalRoyal Stoke University Hospital
Procedure-specific teams:
MERIT (Mobile Emergency Rapid Intubating Team)
Vascular Access
Proning
Other
Family liaison		Anaesthetists-led MERIT.
Vascular access teams set up but not needed—procedures performed by PICU teams.
Proning teams included paediatric physiotherapists.
Dedicated tracheostomy lists.
Non-critical care consultants led on MDT and existing PICU family liaison nurses.		Anaesthetists-led.
Adult and paediatric respiratory nurse specialists led on tracheostomy safety rounds.
Non-critical care consultants (adults and paediatric directorate) led on MDT and family liaison.		Airway team. Anaesthetists-led, with staff rota.
Vascular access teams—MDT staff including surgical and transplant consultants.
Proning teams MDT staff.
Weekly dedicated tracheostomy theatre list.
Adult ID ward round.
Clinical psychologists, medical and nursing staff family liaison teams.		Anaesthetist-led, with staff rota including consultant paediatric surgeons.
Consultant paediatric surgeon led with staff rota of paediatric respiratory consultants, PICU nurse consultants and non-PICU consultants.		Task teams set up, but was not required.
Existing PICU Family Care Team of band 6 and band 7 nurses.		Anaesthetists-led.
Existing PICU family liaison nurses.		AICU staff-led.
PICU medical and nursing staff.
Clinical resources developed for adult patients

  • COVID daily ward round template (appendix).

  • Quick nursing guides (appendix).

  • Quick reference guide to common AICU medications.

  • Ward round template as per AICU.

  • Handover operational checklist.

  • Common Medicines Quick Guide (appendix).

  • Extubation algorithm (appendix).

  • Tracheostomy referral form.

COVID checklists for daily plans.
Research guide including patient selection and contacts.

  • AICU admission sheet.

  • Daily documentation adapted into PICU EPR, including all communication and procedures.

  • Nursing documentation added to electronic medical records.

- Electronic patient information system integrated with adult documentation including a simplified specific COVID Daily Ward Round template.
‘Idiot’s Guide to COVID Intensive Care’ developed by AICU team.
PICM and AICM trainees developed a ‘differences between PICU and AICU’ guide.

  • Adult guidelines app.

  • Same clinical information system for adults as for PICU.

  • Admission and discharge on EPR.

  • Patient Data Management System as per AICU to access all adult guidelines.

  • Paediatric bedside charts for fluid balance.

CommunicationsDaily AICU/PICU/anaesthetics meetings to clarify operational logistics.
Daily management leadership dial-in updates on latest operational issues.
Three times per week respiratory/ICU MDT.
Dedicated mobile phones for referrals, investigation requests and family communications.
Microsoft teams for communication between ‘red’ and ‘green’ zones.		Daily respiratory, radiology, pharmacy, family liaison rounds.
Regular visiting consults from microbiology, haematology, pulmonary hypertension, neurology, nephrology.
Webcam on all bed spaces.
Microsoft teams for full range of virtual rounds (including education, and governance) across all three operational critical care areas.		Coordinating AICU consultant on every shift.
Joint MDT decision-making for complex patients and end-of-life discussions.
WhatsApp and email between AICU and PICU.
Daily calls to updates families and access to video calling.
‘Walkie talkies’ and dedicated phone lines to cubicles and bays, wipeable white boards.		Daily tactical leadership teleconference with local adult CCN to identify operational issues and potential patient transfers.
Twice daily nurse huddles and medical handovers; daily micro/ID consults and family liaison rounds.
Liaise with adult colleagues on challenging or end-of-life decisions.
Microsoft teams for communications across all critical care pods.		Twice daily Silver Command meetings
Reverted to historic numerical assignment of the wards instead of naming as “PICU” during the mixed board of adult and paediatric patients
Well-being hubs
Microsoft Teams for twice weekly Infectious Diseases Rounds		Daily tactical leadership updates to clarify operational issues
Well-being hubs.
Pharmacy, procurement and HR included in leadership updates.
Microsoft teams in use.		Twice daily ward round by paediatric staff including adult pharmacist.
Twice daily ward round by AICU consultant.
Daily/twice daily medical and nursing team huddle to provide mutual support.

  • MDT, multidisciplinary team; PICU, paediatric intensive care unit; RRT, renal replacement therapy.