Negative pressure, positive attitude: How faculty and staff came together to activate the RICU

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In early March 2020, the threat of coronavirus seemed distant for many Michiganders. However, leadership at Michigan Medicine recognized that the pandemic would be hitting the state soon and quickly started preparations to admit COVID-19 positive patients.

Led by UH/CVC and C&W administration, the cross-functional team of medical directors, nursing directors, hospital facilities, clinical engineering, environmental services, patient equipment, pharmacy, respiratory therapy, infection prevention and other support teams converted the 12 East unit from general care pediatric rooms to adult ICU rooms, operating completely under negative pressure, in one week. Located on the 12^th floor, east end, of C.S. Mott Children’s Hospital, the Regional Infectious Containment Unit, or RICU, was soon activated with 32 beds and later expanded to 50 beds.

“While no one wishes to have to activate, having this highly unique space allowed for safe handling of more complex COVID-19 patients,” said Bob Harris, associate health system director for facilities operations.

Part of the design

Hospital rooms designed for isolation and specialized ventilation was part of the design when Mott was built. These rooms have high-efficiency particulate air (HEPA) filtration systems and were converted to negative pressure, which essentially means the building exhausts more air out of the room than is supplied into the rooms. This minimizes the risk of airborne pathogen transmission for faculty, staff and others working in the hospital. Negative pressure is particularly important for critical patients with COVID-19 who are undergoing specialized procedures that have a risk of forming droplets, or aerosols, that can transmit the virus.

“The team decided to empty the unit of existing pediatric equipment and beds, clean it and then furnish with ICU beds, supply carts, computers and equipment needed to care for our new patients,” said Lamia Marouf, project manager with UH/CVC administration, noting that the patients who were on 12 East were relocated to other general care areas within Mott. “The entire team worked many hours and demonstrated tremendous dedication and commitment to ensure the successful and safe activation of the RICU unit.”

Medical staff moves in

Vineet Chopra, M.D., division chief of hospital, served as medical director for the unit as it opened, along with Valerie Vaughn, M.D. and Chris Smith, M.D. as co-directors.  The RICU began with a team of hospital medicine doctors, critical care doctors, infectious disease doctors, kidney doctors, respiratory therapists, pharmacists, nurses and social workers.  As additional needs were identified, specialists in palliative care join the team.

“I have been heartened to see how many of our physicians, nurses and respiratory therapists stepped forward to activate the RICU. Our initial team was made up of volunteers — their commitment and willingness to serve was unparalleled,” said Chopra.

The team rounded together to share knowledge and quickly incorporate learning into guidance documents. They recognized that many of the physicians who would eventually work in this area may not have direct experience caring for critically-ill patients on ventilators and specialized medicines. The team created one-hour lectures on these topics and made them available for training purposes.

“I have never been so proud to work at the University of Michigan,” said Vaughn, who played a vital role in activating the unit. “There was very little information early on and a lot of misinformation about COVID-19. But so many people from all specialties came forward to volunteer, despite knowing it might affect their own safety and families. They often had to take a new role and learn quickly.”

Nursing ‘village’ steps up

“It truly took a village of people to get the RICU opened and functional,” said Julie Juno, R.N., co-clinical nursing director for the RICU along with MaryAnn Adamczyk, R.N.

In a short time, nursing stepped up with 275 volunteers coming from various parts of the hospital, many having never worked with each other. The first group deployed was made up of experienced intensive care nurses who were prepared for any level of acuity in patients and comfortable working in the negative pressure environment with special personal protective equipment (PPE). As new nurses volunteered on the unit, they were partnered with more experienced counterparts to quickly learn the protocols.

Nurse leaders were tasked with setting up workflow and creating structure. They also set up a core staff schedule to create stability for patients and the functioning of the RICU.

“Even though we are working in an environment that provides negative pressure for infection containment, we are choosing to have a positive attitude to support our patients and each other,” said Juno. “We are proud to care for our patients, families and each other at this very challenging time.”

Important work everywhere

Since the RICU was activated, teams have worked to set up other negative pressure rooms to meet the surge in patients. In fact, more than 100 ICU-level rooms are now ready for use across Michigan Medicine.

The organization thanks all of the faculty and staff who are assigned to those areas. Your hard work and determination does not go unnoticed!

While the hospital is prepared to handle more COVID-19 patients, social distancing measures are flattening the curve at Michigan Medicine. The goal now is to prevent a second spike.

Stay home if you can, practice social distancing when appropriate and stay safe!