Sunnybrook study measures the impact of expanding critical care capacity beyond the ICU

When intensive care units (ICUs) began filling up in the early days of the COVID-19 pandemic, hospitals including Sunnybrook explored new ways to deliver care to patients amid limited capacity. A new study published this week in the Journal of General Internal Medicine demonstrates the impact one innovation in care had on patients and hospital resources.

“Prior to the COVID-19 pandemic, humidified oxygen therapy known as high-flow nasal cannula (HFNC) oxygen therapy, was only administered to patients in intensive care units,” says Dr. Jonathan Zipursky, staff physician and scientist at Sunnybrook Health Sciences Centre. “In late 2020, we launched an innovative, interdisciplinary care model where we offered HFNC outside of the ICU in general medicine floors as a way to expand our hospital’s ICU capacity and treat more patients.”

HFNC oxygen therapy can be given to patients in respiratory distress, including those with COVID-19. In order to deliver HFNC outside of the ICU, multiple interdisciplinary stakeholders were engaged at Sunnybrook including respiratory therapy, nursing, critical care and general medicine to deliver appropriate training and resources to care for these patients on the general medicine wards.

The authors found that offering HFNC oxygen therapy on general medicine wards offloaded ICU capacity upwards of 20% by managing up to 14 patients per day. They also found the outcomes of patients treated were not different than those treated in the ICU.

“Our study is the first, to our knowledge, to quantify the degree to which ICU capacity was offloaded by offering HFNC on GIM wards,” says Dr. William Silverstein, lead author of the study and General Internal Medicine Fellow at the University of Toronto. “Although further studies are needed to validate the safety and feasibility of this care model for the broader health care system, we believe these results will have important implications for addressing continued patient volume surges and capacity challenges.”

Read the full paper in the Journal of General Internal Medicine.