Planning for a COVID-19 Pandemic – Metrics and Data Monitoring

ANZICS recognises that metrics and data collection have been invaluable during the COVID-19 pandemic. The development of the Critical Health Resources Information System (CHRIS), a nationwide ICU dashboard which collects information twice daily and has allowed access to real-time data on ICU activity and capacity. This has helped to facilitate load rebalancing during periods of health system strain in Australia.

We recommend that processes established during the pandemic which have ongoing value (e.g. CHRIS) be integrated into routine health service provision on a permanent basis with appropriate government support and funding.

We recommend the expanded use of electronic health records to ensure ongoing data collection for research purposes whilst minimising the number of required research staff and reducing their exposure.

ANZICS advocates for a whole-of-health systems approach which requires mechanisms that have a broad overarching view of current and projected demand on the healthcare system, including critical care services.

This approach is required not only for the current pandemic but is valuable at any other times of strain for the healthcare service e.g. natural disaster, extreme weather event, mass casualty event.

A whole-of-health systems strategy requires collection of information about:

• Individual patients
• ICUs and hospitals to ensure measurement of resources (e.g. staff, ICU beds)
• Processes of care (e.g. routine VTE prophylaxis, specific treatments for COVID-19)
• Outcomes (e.g. mortality, length of stay, disability, and long-term survival).

To ensure an informed, coordinated and adaptive response to the pandemic, we recommend that relevant information should be collected about:

1. Intensive Care Units

• Operational information about ICU demand, capacity and resources
• System planning information about infrastructure, resources and processes of care

2. Individual patients

• Registry-level information about demographics and outcomes of all ICU patients
• Epidemiological information about COVID-19 patients
• Targeted in-depth information for interventional clinical trials

3. Staff

• Wellbeing and workload
• Infection control and vaccination.

We recognise that the relevance/importance of individual metrics and data sets listed below may change over time and recommend that these data sets evolve to keep pace with scientific knowledge and changes within the healthcare service. This may include the inclusion of biologic samples.

Real-time operational data

Demand for ICU services, overall available resources and operational capacity should be monitored at least daily, with information from every ICU. We recommend that operational information should include total numbers of:

• Available and physical ICU beds
• All critically ill patients occupying ICU beds, including information on specific therapies such as mechanical ventilation and renal replacement therapy
• COVID-19 patients including information on those who require mechanical ventilation.

We recommend that aggregate reports derived from this data be made widely available to all stakeholders including clinicians, health departments and the public (e.g. a real-time dashboard such as CHRIS).

Snap-shot in-depth surveys

These surveys provide more in-depth information about resources, hospital processes of care and targeted patient information at particular points in time. We recommend that the benefits of the detailed information obtained from such surveys be balanced against the burden and frequency of data collection.

The ANZICS Surge Survey provided detailed information on potential ICU physical bed capacity, equipment, isolation rooms and staffing in response to the increased demand caused by the COVID-19 pandemic. We recommend the annual routine collection of information about baseline ICU resources, staffing, costs/funding and processes of care through the ANZICS Critical Care Resources Registry Survey.

The ANZICS CTG point prevalence program collects observational data at a single time point and has been used to provide opportunities for capacity growth and development of research programs.

ANZICS recommends that both real-time data monitoring and snapshot surveys be used to provide data for the predictive modelling of demand and that this demand be matched to available resources and capacity.

Routine monitoring of all ICU patients

ANZICS recommends that the routine collection of a minimum patient dataset with reporting of this information through the ANZICS Centre for Outcome and Resource Evaluation clinical quality registry program, should be maintained, even at peak times of the pandemic.

This ensures a usual standard of care is being delivered to all ICU patients including those with COVID-19 and allows for benchmarking at a local, national and international level. Failure to submit timely data should in itself be considered a potential marker of poor quality of care or system strain at an ICU.

Epidemiology of COVID-19 patients admitted to ICU

We strongly recommend the contribution of information to a detailed patient level dataset which collects information on specific characteristics, treatments, and outcomes of critically ill patients with COVID-19 such as the Monash University SPRINT SARI study.

This information allows:

• Reporting of overall demographics and outcomes of patients with COVID-19
• Assessment of contemporary treatment trends (such as the increased use of proning and high-flow nasal oxygen during the first year of the pandemic)
• Translation of research into clinical practice (such as the adoption of steroids).

Clinical Trials

Interventional clinical trials have been pivotal in the development of new therapies for the treatment of COVID-19. We strongly recommend the inclusion of patients to both observational and interventional clinical trials (e.g. SPRINT-SARI and REMAP-CAP).

We encourage the alignment of individual data elements with pre-existing collection mechanisms by:

• Using standardised data definitions
• Multisite collaborations
• Using pre-existing clinical quality registries
• Research partnerships
• Facilitating the data linkage of pre-existing information (e.g. the national death index for long-term survival data)

This approach minimises duplication and the additional burden of unnecessary data collection. Data collected for other purposes should be done so within a framework which allows potential use for other purposes while maintaining individual patient confidentiality.

We recommend that ICUs collect, maintain and report data related to rostering and workload. In particular, this should include information on deployment of non-critical care trained staff to ICU. This should be used to anticipate and plan for changes in workforce demand during different phases of the pandemic.

In order to support healthcare leaders in monitoring staff wellbeing, we recommend collection and reporting of data related to staff stress and burnout.

This may include factors such as:

• System stressors (staffing levels, patient/staff ratios)
• Retention and recruitment of staff
• Indicators of staff in difficulty (complaints and errors).

To ensure staff safety, we recommend that ICUs maintain records of:

• Vaccination status
• Mask fit testing
• PPE training and competence
• Participation in surveillance screening (if required)
• Staff impacted by COVID-19 exposure
• Staff furlough
• Staff COVID-19 infection.

This helps to protect individual staff members, their colleagues, and patients from infection, and allows targeted support for those who need it most. In addition, it is important to ensure these data are available to ICU staff for local operational purposes.