Prepared for anything

by George Gardiner

Handling the effects of COVID-19 pushed one doctor to the edge of despair but good preparation saw his team through

Location: Northern Ireland
Published: Wednesday 1 July 2020

My role as CD (clinical director) for the ICU in Belfast’s City and Mater Hospitals meant that I became the CD for the COVID-19 cohort ICU for Belfast and subsequently the Nightingale Hospital set up in the City hospital tower building. 

Initially, my experience of covid was as a clinical manager helping to set up a service to face a disease which was coming towards us in numbers predicted to be anything from barely manageable to overwhelming. As the rate of admissions slowed and the threat of having to open critical care areas on multiple levels in Belfast City Hospital Tower receded, I was able to join colleagues as a clinician on the resident shift system in the Nightingale Hospital.

We expected and planned for many more patients than we received, though briefly the admission rate seemed to be rising faster than we could mobilise staff and open beds. My colleagues succeeded in preparing clinical areas for use as intensive care and preparing staff from other areas to work within it. Their efforts in the few weeks before the patients started to arrive were truly remarkable - approximately 1,000 staff from all disciplines had an induction to critical care in some form, and 78 beds were ready to take patients with more in reserve.

I think we all expected the mortality to be high and the work to be exhausting. As it turned out, the outcomes were much better than we had feared but the levels of delirium and burden of multiple organ failure was much higher. Placing patients prone and managing multiple supportive therapies while communicating with everyone in PPE (personal protective equipment) was challenging, as was having to get by with paper notes, charts and prescriptions instead of our computer-based records and prescribing systems. Yet the teams solved those problems with some pragmatic and some ‘tech’ workarounds. Shift work was collegiate, effective but exhausting and nights were particularly unloved - definitely a low point along with the uncertainty about how long the first wave was going to last.

The high points have got to be watching patients finally leave ICU after prolonged stays, working with colleagues who were entirely out of their comfort zone yet enthusiastic and focused, and finally getting out of PPE. The outcomes that have been achieved across critical care units in Northern Ireland has been exceptional, so too has the provision of acute care in all areas. The health service here in every discipline and trade has responded to the crisis with resolve.

For the next surge we need to find a way to preserve more services and lessen the impact of Covid on staff and patients.  At the same time we need to establish the operating parameters for this phase of the disease and look forward to what we can achieve in future given the restrictions we will face in terms of staffing, space and resources. We need to manage our own expectations before moving on to managing those of our patients and our politicians.

George Gardiner is a consultant in anaesthetics and critical care medicine