• Sarah M Kesler, Christina Bastin De Jong, Christine Chell, Debra DeBruin, Heidi L Erickson, Kimberly A Goodman, Walter James, Jason Kallestad, Tom Klemond, Erin McLachlan, Cheryl Petersen-Kroeber, James Risser, Erin S DeMartino, Alexandra T Waterman, Susan M Wolf, Joel Wu, Clara Zamorano, Karyn Baum, Daniel Brown, Joshua Cohen, Deanna Diebold, Jennifer A Fischer, Kay Greenlee, John Hick, Paul Kettler, Michele LeClaire, Jacob Lyons, Sean MacDonell, Kyle Mairose, Andrea Boehland, Joseph Martinelli, Elizabeth A Miller, David E Niccum, Ronald Reilkoff, Judy Seaberg, Nneka O Sederstrom, Adam Shadiow, Shawn Stoen, Helen Strike, Ken K Maslonka, Jack M Wolf, Jennifer Schoenecker, Jeffrey R Dichter, and Minnesota Critical Care Working Group.
• University of Minnesota.
• Chest. 2024 Nov 27.

BackgroundAt the request of the Statewide Healthcare Coordination Center, the Minnesota Critical Care Working Group (CCWG) and ethics subgroup (EWG), composed of interprofessional leaders from Minnesota's nine largest health systems were asked to plan and coordinate critical care operations during the COVID-19 pandemic, including the 2021 Fall surge.Research QuestionCan a statewide Working Group collaboratively analyze real time evidence to identify crisis conditions and engage state leadership to implement care processes?Study Design And MethodsCCWG/EWG met via video conferencing during the Fall 2021 severe surge to analyze evidence and plan for potential crisis care conditions. Five sources of evidence informed their actions including group consensus on operating conditions; Federal Tele-Tracking data; MOCC patient placement data; and two surveys created and distributed to hospitals and healthcare professionals. The group developed and recommended processes to mitigate the conditions and engaged statewide leadership for support.ResultsEvidence of crisis conditions included rising numbers of inpatient COVID-19 patients, tertiary care centers with difficulty accepting transfers (including emergencies), severe ED crowding, activation of ICU allocation teams, and low patient placement rate at the Minnesota MOCC. A statewide hospital survey demonstrated numerous staffing adaptations, expansion of telemedicine, and delay of non-emergent procedures. A survey of healthcare professionals revealed instances of poor patient outcomes, bedside rationing, implicit triage, and moral distress. Leadership engagement resulted in public messaging, though no change in how ICU care was allocated, or transfers managed.InterpretationCCWG collected and analyzed evidence demonstrating crisis conditions and healthcare professional moral distress during the Fall 2021 COVID-19 surge. However, the group had a limited impact on care processes. This paper analyzes the group's efforts. It includes recommendations for researchers and policy makers.Copyright © 2024 American College of Chest Physicians. All rights reserved.

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