Biological and Clinical Sciences Research Journal
ISSN:
2708-2261
www.bcsrj.com
DOI:
https://doi.org/10.47264/bcsrj0101041
Biol.
Clin. Sci. Res. J., Volume, 2020: e041
News and Views
COVID 19 CRITICAL CARE TRAINING SURGE EXPERIENCE FOR
PHYSICIANS IN RIYADH HEALTH CLUSTER ONE, SAUDI ARABIA
MADY AF1,2*,
RAMADAN O1, ALYOUSEF R3,
ISHAG A4, BAKIROVA G1 , KUHAIL A1, SHAHZAD S1,
EL-ETREBY W1, MUMTAZ S1, ALMOZAINY S3, PALACIO K1, ALDAMAHSHI D3, ALCAZAR A1, ALODAT M1, ABDELRAHMAN B1,
HARTHY
A1
1Critical
Care Department, King Saud Medical City, Riyadh, Saudi Arabia
2Department of Anesthesiology and critical care, Tanta
University Hospitals, Tanta, Egypt
3Organization Development Department, Riyadh Health
Cluster One, Riyadh, Saudi Arabia
4Medical Liaison
Office, King Saud Medical City, Riyadh, Saudi Arabia
Corresponding author email address: afmady@hotmail.com
General Goals and Objectives
As
the COVID-19 pandemic spreads, the number of critically ill patients is
expected to surge in hospitals across the world. This may result in non-ICU
clinicians being needed to care for critically ill patients, In line with
Pandemic COVID – 19 situations that we are facing currently; the Critical Care
Department Training Committee of King Saud Medical City in collaboration with
the Riyadh Health Cluster One, Saudi Arabia conducted a series of training
projects. Its goal is to help non – ICU Physicians to be equipped and be more competent
to handle critically ill patients when the situation will have the need for it.
We aim to provide basic knowledge and skills to successfully manage critically
ill patients with suspected or confirmed COVID – 19 cases in a critical care
setting.
Keywords:
COVID-19, critically ill, training, ICU, physicians
Targeted
Audience
This plan
aims to deliver non-ICU physicians who haven’t received prior formal critical
care training and would like to volunteer or nominated as back up workforce in
covivd-19 crisis. They are being nominated in collaboration with a chain
communication between Organization Development and Academic Affairs, Riyadh 1st
Health Cluster (C1), Postgraduate departments of C1 institutions, Hospitals
medical directors, Head of Departments, KSMC Medical Liaison Office and
training program directors. Three target audiences with different training
approach for each category. First, non – ICU physicians either service
physicians or trainees, which is the most target category of our training plan.
Second, ICU and Anesthesia physicians, the most connected specialty to ICU and
finally, Maternity staff (COVID19 in pregnancy).
Chain of Communication for nomination and deployment
Below a
diagram showing the chain of command from Cluster executives who have detailed
reviewed the Surge staffing plan to the support of Riyadh Health Cluster 1
hospital and medical directors in collaboration with the head of departments
and training program director’s effort in nominating their colleagues through the
communication of COVID19 command center and Medical Liaison Office (MLO). Final
nominees were forwarded to CCD Physicians Affairs Divisions (PAD) through an
email for final deployment.
Fig, 1
Chain of Communication for nomination and deployment of non-ICU physicians
Educational
Training Approaches
The
training committee meticulously organized a series of courses and workshops to accommodate
larger number of participants. The participants will go through 6 phases before
officially joining the workforce on the Frontline.
Fig, 2
phases of training of Non-ICU physicians
Clinical
Training
These
are the following phases
I.
Online Learning (Self – directed): Phase 1
They
are given resources of online courses from Society of Critical Care Medicine free
open and ongoing SCCM's Critical Care for the Non-ICU Clinician as well as The
Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU). They
must take the course as a perquisite to our course so as to build an idea of
the intended theoretical learning objective for basic critical care and COVID –
19. MBRU have designed a free online course titled “Let's Break the Chain of
COVID-19 Infection”, as part of the MBRU Community Immunity Ambassador Program.
This program will provide you with rapid training on key aspects of infection
and immunity to empower you on how to prevent and control the spread of COVID-19.
The course covers the chain of infection, how infectious diseases are
transmitted and how to break the chain of infection through concrete preventive
actions.
II.
Online Critical Care Courses: Phase 2
A
series of courses conducted in an interactive virtual setting set to focus on
topics essential and relevant to critical care and COVID 19 (tables 1 and 2)
Table 1
A) Online Critical Care Topics for Non – ICU Physicians
Follows
three major domains:
1-
Essentials of critical care
ABG Interpretation
Shock and Fluid Resuscitation
Essentials of Mechanical Ventilation
2- HCW
Safety during COVID19
Infection Control for COVID – 19
Aerosolized generating procedures
STAY SAFE: Open Discussion
3-
COVID19 management
Pathway & Definitions of COVID – 19
Quick Guide for Management of Critically Ill
patients with COVID – 19
COVID – 19: A Pathological Approach to
Management
ARDS in COVID – 19
Pharmacology of COVID – 19
COVID 19 Pneumonia
CPR Dynamics in COVID – 19
COVID Intubation, Transfer of Patients,
Airway Management (with simulation Videos)
B)
COVID – 19 Infection & Pregnancy
Overview of COVID – 19 Diagnosis &
Management Protocols
COVID – 19 in Pregnancy (Case Definition
& Pathways)
COVID – 19 in Pregnancy: General Management
Infection Control Precautions & PPR
Recommendations
Airway Management and special considerations
in pregnancy
Pharmacology of COVID19 in Pregnancy
CPR & Considerations in pregnancy
C)
Online Critical Care Course for ICU & Anesthesia Physicians
Definition, Clinical Presentation – Triage
PPE – Donning and Doffing
Pathophysiology of COVID19
Diagnostic Testing & Severity of COVID19
ARDS COVID Basic and advanced management
Pharmacology in COVID – 19
Novel modalities: Convalescent Plasma and
Plasmapheresis
Aerosol Generating Procedures – AGP
Cluster COVID – 19 Protocol Awareness
Table 2 Courses Dates & Number of Attendees
|
leCourse Tit |
Date |
Number
of Attendees |
|
1st Online Critical Care
Course for Non- ICU Physician |
April 5 - 8, 2020 |
69 |
|
2nd Online Critical
Care Course for Non- KU Physicians |
April 12.15, 2020 |
60 |
|
3rd Online Critical Care Course for Non- ICU
Physicians |
April 19-20 & 22-23, 2020 |
75 |
|
4th Online Critical
Care Course for ICU & Anesthesia Physicians |
May 4 - 5, 2020 |
61 |
|
5th Online Critical
Care Course for Non- ICU Physicians |
May 12 -14, 2020 |
34 |
|
6th Online Critical Care Course for Non- ICU
Physicians |
May 19 - 21, 2020 |
32 |
|
7th Online Critical
Care Course for Non- ICU Physicians |
June 2 -4, 2020 |
109 |
|
8th Online Critical
Care Course for Non- ICU Physicians |
June 16 -18, 2020 |
32 |
|
9th COVID 19 Infection & Pregnancy (Mixed Pklicians & Musa) |
25-Jun-20 |
62 |
|
10th Online Critical Care Course for Non- ICU
Physicians |
July 13 —15, 2020 |
Expected:
85 |
|
11th Online Critical Care Course for Non- ICU
Physicians |
Aug. 3 — 5, 2020 |
Expected:
85 |
|
Total number trained |
|
534 |
III.
MCQs Assessment: Phase 3
At the
end of the session, 40 Multiple-Choice Questionnaires (MCQs) were distributed.
This is to evaluate the participants’ understanding in all topics presented. Once
passed, he/she will proceed to the next phase which is clinical training.
IV.
Clinical Training: Phase 4
In
adherence with the COVID19 precautionary measures under the Infection control
recommendation, there
were 3 stations organized within ICU premises. These stations namely Basic Airway
Management; Basics of Mechanical Ventilation and infection control measures and
Personal Protective Equipment ( table 3) . Each
participant was rotated every 40 minutes following the 6:1 trainee/trainer
ratio per station. Then, competencies were being administered utilizing the
Saudi Commission for Health Specialists (SCFHS) Competency forms. Every
competency involves interactive and participants were allotted time to seek
questions that were unclear to them.
Table 3
Clinical Training workshops
A) Airway management: Building on established BLS skills:
Safe two hand face - mask bagging to optimize
seal and minimize aerosolization.
Oropharyngeal and nasopharyngeal airway selection and insertion.
Rescue airways insertion: Supraglottic
airway (laryngeal mask).
B) Ventilator management:
Provide instruction on dealing with different
type of oxygen delivery system that are required for critical ill COVID- 19
patients:
High flow nasal cannula
(HFNC)
Invasive mechanical ventilators (IV)
Non-invasive mechanical ventilators (NIV)
Hands on practice for setting and adjusting
basic ventilator settings:
Respiratory rate
Tidal volume
Fractional inspired oxygen (FiO2)
Positive end expiratory pressure (PEEP)
c) Infection control measures:
Proper use of Personal Protective Equipment
(PPE) e.g. N95 mask, PAPR etc…
Donning and doffing
V. Orientation
and Preparation for Joining: Phase 5
Introduction
to ICU Settings, COVID - 19 protocols, ICU allocation and file orientation,
rotation schedule, job description, psychological preparedness, receiving
questions for queries from them.
VI.
Deployment and Joining: Phase 6
In
charged division; ICU Physician Affairs Division (PAD) ,
Roles: KSMC ICU Physicians and Non-ICU Manpower in charged; Cluster A1
ICU Staffing plan
and ICU
Physician support deployment, ROTA & Logistics
Process: Once non-ICU physician’s nominees from department heads
is received through ICU email. Automatically their names will
be added in the database for Surge plan. Fig 2
Fig 2 Non-ICU
Physicians Deployment at ICU of King Saud Medical City
Training
Evaluation and Feedbacks
A
survey was distributed to all participants before and after of each course to
assess their readiness and satisfaction. Tab 4
Tab 4 Training
Evaluation and Feedbacks
Positive
Feedbacks:
Remarkable Speakers
Easy and Accessible anytime, anywhere with
good internet connection
Informative Course
Point to be improved:
Need more detailed and deeper ICU Course
Arranging between presenters to avoid
repetition
Time management
Topics too advanced for Non- ICU Audience
Insightful
Analysis
Even
though this Pandemic struck us all hard in the gut, we proved that with hard
work and team work we can do impossible things. Due to this crisis, we came
hand in hand in preparing our Front liners to be the best in caring COVID – 19
patients. We have set aside our own indifference for all the greater good… etc.
Points
to Ponder
Our aim is to help as many physicians as
possible to be prepared for this crisis, however we
cannot avoid issues along the way.
Geographical location of the attendees
affecting the internet quality. For instance, during the course poor quality
internet reception is a major factor. Considering different locations of
attendees, thus some episodes of buffering occurred while lectures were ongoing.
Nomination of participants, we are grateful
that almost all departments are nominating physicians to participate but it
turns out sometimes the nominated physician doesn’t know he is being nominated
therefor resulting to cancellation or participant being absent.
We faced some difficulties for doing the
practical part of training due to social distancing precautions, infection
control instructions and shortage of spacing but we did our best to compensate
and focusing on bedside clinical training at joining to ICU,
Demographic summary, Average Age Group was 35
(25-59) years old but we still have few elder physicians which are categorized
as high risk in COVID19, Common Comorbidities among participants were
Hypertension & Diabetes Mellitus which considered high risk during COVID19
Untimely date. During these periods majority
of the attendees were Residents, who were at a time occupied in preparation of
their upcoming promotion exams while some completed the training programs and
served the covid-19 crisis
Subspecialty conflict. Non familiarization of
the topics. Some specialties are not connected to ICU; oftentimes we are facing
difficulties in extensive information being delivered to them like Dermatology,
Radiology, etc.
COVID 19 Crisis surge; the same attendees
were a time attached to serve the ICU and ER covid-19 surge coverage. Tough
time for everyone who was not accustomed to a hectic duty schedule in an
unfamiliar place. Deliberately, less were able to proceed due to this conflict.
Thus, future courses will be offered to accommodate everyone who is willing to
participate but with the same concern.
Acknowledgment
It has
been an ultimate mission on our part as organizers to deliver the most
effective and quality course in ICU. Now, as this pandemic has led us to adopt
the current trend of online teachings. It is of great privilege in recognizing
the support of the KSMC executives under the patronage of Dr. Ahmed Alenezi, ICU administration headed by CCD energetic mentor
our very own supportive Medical Director -Dr. Abdulrahman
Al Harthy, Riyadh Health Cluster One executives to
KSMC head of departments, Dr. Rafah Saleh Alyousef (Vice President of
Organization Development of Riyadh Health Cluster One), Ms. Shatha
Hamza Almozainy (Strategic
planning & Development of Human Capital Director), Ms. Dimah
Aldamahshi (Organization Development Specialist), Ms.
Kristene Palacio and Ms. Emiliana
Alvarez (CCD Coordinators) and the technical and scientific expert Dr. Ahmed Kuhail and Dr. Gultakin Bakirova academic and program directors, colleagues and the
team whom without their tireless support this course will not be a success.
Lastly, the attendees and knowledgeable speakers (Dr,Ahmed
Mady, Dr, Omar
Ramadan Dr. Basim Huwait
Dr. Mohammad Al Odat Dr. Shahzad Mumtaz, Dr. Ahmed Balshi Dr. Waqas Mahmood Dr. Saima Shahzad Dr. Gultakin Bakirova Dr. Waleed Tharwat El-etreby, Dr. Tasmiya Asad, Dr. Basheer Abdelrahman, Dr. Alhussain Alhazzmi, ) who interactively
shared their knowledge and expertise. The KSMC active
training coordinators. The brilliance and well systematic organization
of manpower strategy headed by Dr. Omar Ramadan with his passionate assistant
Ms. Alva Alcazar and active participation of MLO by Dr. Adam Ishag. Last but never the least to Allah
for giving us the opportunity to resume our mission, not just the KSMC staff
now we’re delivering wider audiences of MOH medical staff in Cluster A1 Riyadh.
Truly,
an esteemed milestone in Critical care department Education and training
division of King Saud Medical City in collaboration of cluster A1 leaders.
References
1http://sccm.informz.net/z/cjUucD9taT05MjA4NTc3JnA9MSZ1PTEwODM2MDM4ODUmbGk9 NzUwMDA3MDQ/index.html
2- https://learn.mbru.ac.ae/courses/covid19