TORONTO GENERAL HOSPITAL’S ICU MANAGEMENT OF THE
COVID-19 PANDEMIC CASE STUDY SOLUTION
e
pl
SYNOPSIS
m
Sa
Canada’s COVID-19 case projections for the next month have prompted the leadership team at Toronto
General Hospital (TGH) to begin planning resources to accommodate the new influx of COVID-19 ICU
patients. Key resources for ICU capacity include beds, Physicians, Nurses, and PPE. The current influx of
patients is expected to overwhelm the existing ICU capacity. Current ICU demand arises from two streams
n
of patients coming from either elective surgeries or emergencies. By slowing down elective surgeries in the
tio
operating room, TGH can create some capacity for ICU beds. The optimal proportion of COVID to total
ICU patients must be analyzed including additional considerations such as the impact on physicians and
nurses, existing patients awaiting elective surgeries, and PPE. This case allows students to take on the role
lu
of a hospital leader and make decisions regarding allocating capacity across resource pools to recommend
an effective ICU management action plan.
So
OBJECTIVES
• Understand how to analyze and make decisions in a complex healthcare system with different
stakeholders while adapting to changing patient demands.
• Analyze capacity utilization with different projected demand scenarios and examining the impact of
shifting capacity from different resource pools.
• Identify key considerations when shifting resources for optimizing patient care, how it will impact
different healthcare stakeholders, and be in line with policy prescriptions.
The Case Solution Starts From page 5
,ASSIGNMENT QUESTIONS
1. What were the challenges facing different countries concerning COVID-19 ICU admissions?
2. Who are the key stakeholders and decision makers of TGH and of UHN? How are hospital wide
decisions implemented?
3. Assess the capacity of the TGH’s ICU assuming no changes are made to resources with the influx of
e
COVID patients.
4. Assess the capacity of the TGH’s ICU if modifiable patients from the operating room are decreased to
pl
have 50 per cent COVID to total ICU patients and 75 per cent COVID to total ICU patient proportions.
Which resource(s) is/are constraining the ICU the most? What is the optimal ratio of COVID to total
m
patients in the ICU?
5. What should TGH do to increase their ICU capacity and meet the projected demand in addition to
Sa
changing the COVID patient ratio?
n
tio
lu
So
The Case Solution Starts From page 5
,ANALYSIS
1. What were the challenges facing different countries concerning COVID-19 ICU admissions?
When analyzing the challenges countries are facing by decreasing ICU capacity from COVID-19 patient
demand, students should use case facts to connect their considerations to the different healthcare
stakeholders, namely, patients, healthcare providers, healthcare management, and communities. Due to
COVID-19s impact on countries such as China and Italy prior to impacting Canada’s healthcare system,
students should connect these countries challenges to challenges that Canada may potentially face in the
coming months as Canadian COVID-19 cases increase:
• Lack of public messaging around the virus.
• Lack of education and expertise regarding treating new patients.
• Overburdened ICU utilization due to running ICUs at close to 100 per cent capacity (Italy, Canada).
• Rapid increase in demand and price of PPE in healthcare and public establishments.
e
o Sharing PPE among healthcare professionals and the general public.
• ICU admissions as a lagging indicator to the amount of community transmission causing cases to grow
pl
exponentially crowding ICUs quickly and unexpectedly.
•
m
Sa
n
tio
lu
So
The Case Solution Starts From page 5
, EXHIBIT -1: STATUS QUO UTILIZATION WITH COVID-19 DEMAND
ICU beds Nurses Doctors PPE
Utilization Metric (per Patient-days per month Number of nurse shifts Shift hours Number of N-95 masks
month basis)
Pre COVID-19 demand 𝟑 × 𝟕𝟏𝟖 = 𝟐, 𝟏𝟓𝟒 𝟐, 𝟏𝟓𝟒 × 𝟏 × 𝟐 = 𝟒, 𝟑𝟎𝟖 𝟐. 𝟏𝟓𝟒 × 𝟏. 𝟑𝟑 × 𝟐 = 𝟏𝟎 × 𝟕𝟏𝟖 = 𝟕, 𝟏𝟖𝟎
𝟓, 𝟕𝟑𝟎
COVID to non-COVID 𝟐𝟖𝟐 (𝟏. 𝟓 × 𝟐𝟖. 𝟐%) + (𝟐 × 𝟐𝟖. 𝟐%) + (𝟒𝟎 × 𝟐𝟖. 𝟐%)
= 𝟐𝟖. 𝟐%
weighted average 𝟏𝟎𝟎𝟎 (𝟏. 𝟎 × (𝟏 − 𝟐𝟖. 𝟐%)) = (𝟏. 𝟑𝟑 × (𝟏 − + (𝟏𝟎 × (𝟏 − 𝟐𝟖. 𝟐%))
e
𝟏. 𝟐 𝟐𝟖. 𝟐%)) = 𝟏. 𝟔𝟎 = 𝟏𝟖. 𝟓
(𝟓 × 𝟐𝟖. 𝟐%) + (𝟑 ×
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(𝟏 − 𝟐𝟖. 𝟐%)) = 𝟑. 𝟓𝟔
COVID-19 demand (𝟏𝟎𝟎𝟎 × 𝟑. 𝟓𝟔) = 𝟑, 𝟓𝟔𝟑
m
Sa
n
tio
lu
So
The Case Solution Starts From page 5
COVID-19 PANDEMIC CASE STUDY SOLUTION
e
pl
SYNOPSIS
m
Sa
Canada’s COVID-19 case projections for the next month have prompted the leadership team at Toronto
General Hospital (TGH) to begin planning resources to accommodate the new influx of COVID-19 ICU
patients. Key resources for ICU capacity include beds, Physicians, Nurses, and PPE. The current influx of
patients is expected to overwhelm the existing ICU capacity. Current ICU demand arises from two streams
n
of patients coming from either elective surgeries or emergencies. By slowing down elective surgeries in the
tio
operating room, TGH can create some capacity for ICU beds. The optimal proportion of COVID to total
ICU patients must be analyzed including additional considerations such as the impact on physicians and
nurses, existing patients awaiting elective surgeries, and PPE. This case allows students to take on the role
lu
of a hospital leader and make decisions regarding allocating capacity across resource pools to recommend
an effective ICU management action plan.
So
OBJECTIVES
• Understand how to analyze and make decisions in a complex healthcare system with different
stakeholders while adapting to changing patient demands.
• Analyze capacity utilization with different projected demand scenarios and examining the impact of
shifting capacity from different resource pools.
• Identify key considerations when shifting resources for optimizing patient care, how it will impact
different healthcare stakeholders, and be in line with policy prescriptions.
The Case Solution Starts From page 5
,ASSIGNMENT QUESTIONS
1. What were the challenges facing different countries concerning COVID-19 ICU admissions?
2. Who are the key stakeholders and decision makers of TGH and of UHN? How are hospital wide
decisions implemented?
3. Assess the capacity of the TGH’s ICU assuming no changes are made to resources with the influx of
e
COVID patients.
4. Assess the capacity of the TGH’s ICU if modifiable patients from the operating room are decreased to
pl
have 50 per cent COVID to total ICU patients and 75 per cent COVID to total ICU patient proportions.
Which resource(s) is/are constraining the ICU the most? What is the optimal ratio of COVID to total
m
patients in the ICU?
5. What should TGH do to increase their ICU capacity and meet the projected demand in addition to
Sa
changing the COVID patient ratio?
n
tio
lu
So
The Case Solution Starts From page 5
,ANALYSIS
1. What were the challenges facing different countries concerning COVID-19 ICU admissions?
When analyzing the challenges countries are facing by decreasing ICU capacity from COVID-19 patient
demand, students should use case facts to connect their considerations to the different healthcare
stakeholders, namely, patients, healthcare providers, healthcare management, and communities. Due to
COVID-19s impact on countries such as China and Italy prior to impacting Canada’s healthcare system,
students should connect these countries challenges to challenges that Canada may potentially face in the
coming months as Canadian COVID-19 cases increase:
• Lack of public messaging around the virus.
• Lack of education and expertise regarding treating new patients.
• Overburdened ICU utilization due to running ICUs at close to 100 per cent capacity (Italy, Canada).
• Rapid increase in demand and price of PPE in healthcare and public establishments.
e
o Sharing PPE among healthcare professionals and the general public.
• ICU admissions as a lagging indicator to the amount of community transmission causing cases to grow
pl
exponentially crowding ICUs quickly and unexpectedly.
•
m
Sa
n
tio
lu
So
The Case Solution Starts From page 5
, EXHIBIT -1: STATUS QUO UTILIZATION WITH COVID-19 DEMAND
ICU beds Nurses Doctors PPE
Utilization Metric (per Patient-days per month Number of nurse shifts Shift hours Number of N-95 masks
month basis)
Pre COVID-19 demand 𝟑 × 𝟕𝟏𝟖 = 𝟐, 𝟏𝟓𝟒 𝟐, 𝟏𝟓𝟒 × 𝟏 × 𝟐 = 𝟒, 𝟑𝟎𝟖 𝟐. 𝟏𝟓𝟒 × 𝟏. 𝟑𝟑 × 𝟐 = 𝟏𝟎 × 𝟕𝟏𝟖 = 𝟕, 𝟏𝟖𝟎
𝟓, 𝟕𝟑𝟎
COVID to non-COVID 𝟐𝟖𝟐 (𝟏. 𝟓 × 𝟐𝟖. 𝟐%) + (𝟐 × 𝟐𝟖. 𝟐%) + (𝟒𝟎 × 𝟐𝟖. 𝟐%)
= 𝟐𝟖. 𝟐%
weighted average 𝟏𝟎𝟎𝟎 (𝟏. 𝟎 × (𝟏 − 𝟐𝟖. 𝟐%)) = (𝟏. 𝟑𝟑 × (𝟏 − + (𝟏𝟎 × (𝟏 − 𝟐𝟖. 𝟐%))
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𝟏. 𝟐 𝟐𝟖. 𝟐%)) = 𝟏. 𝟔𝟎 = 𝟏𝟖. 𝟓
(𝟓 × 𝟐𝟖. 𝟐%) + (𝟑 ×
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(𝟏 − 𝟐𝟖. 𝟐%)) = 𝟑. 𝟓𝟔
COVID-19 demand (𝟏𝟎𝟎𝟎 × 𝟑. 𝟓𝟔) = 𝟑, 𝟓𝟔𝟑
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The Case Solution Starts From page 5
