Ventilator Acquisition and Distribution Within a Regional Hospital System During the COVID-19 Pandemic

Abstract

Background: The COVID-19 pandemic led to extensive numbers of patients requiring mechanical ventilation. Partners Healthcare System, Boston, MA, includes two academic medical centers, 7 community hospitals, and two rehabilitation centers. To ensure appropriate ventilator distribution across this system, the system’s Incident Command assembled a Ventilator Crisis Team (VCT).

Methods: The VCT includes a critical care physician, the assistant director of respiratory care, medical director of biomedical engineering, director of anesthesia biomedical engineering, manager of the supply chain, and a project specialist. Data was collected from each institution within the system, detailing number and type of mechanical ventilators as well as current and potential ICU bed space. The VCT met twice daily to address long-term strategies for acquisition of additional mechanical ventilators. A database was created matching unique disposables to ventilators, for easy allocation. Daily census information from each site was analyzed by the MD and RRT team members and included current and available usage of ventilators and beds. If a hospital was identified as needing more devices, the MD and RRT team members devised an allocation plan with focus on maintaining the greatest number of patients on ICU ventilators, allocating the same brand of devices already employed at that site, and distributing ventilators ahead of a surge.

Results: From March 23rd to May 11th, 2020 at peak, 375 patients requiring mechanical ventilation were cared for across the system. To accomplish this, 345 ventilators were allocated. This includes 108 newly acquired ventilators, 132 ventilators relocated from an area of low use to an area of high need, 95 ventilators loaned from the Strategic National Stockpile and other regional hospitals, and 10 ventilators received through donation. No patient transfers occurred due to lack of durable equipment or consumable materials.

Conclusions: The projected number of patients requiring mechanical ventilation during the COVID-19 pandemic exceeded the number of available ventilators at each hospital within our system. Understanding the types of mechanical ventilators used at each institution allowed for allocation of like devices, reducing the need for significant education during times of high workload and stress. Equipment transfers to institution of patient admission reduced the need for transport of patients, as well as avoided strain on any one part of the hospital system.