Fast reshaping of intensive care unit facilities in a large metropolitan hospital in Milan, Italy: Facing the COVID-19 pandemic emergency

At the end of 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak spread from China all around the world, causing thousands of deaths. In Italy, the hardest hit region was Lombardy, with the first reported case on 20 February 2020. San Raffaele Scientific Institute — a large tertiary hospital and research centre in Milan, Italy — was immediately involved in the management of the public health emergency. Since the beginning of the outbreak, the elective surgical activity of the hospital was rapidly reduced and large areas of the hospital were simultaneously reorganised to admit and assist patients with coronavirus disease 2019 (COVID-19). In addition, the hospital became the regional referral hub for cardiovascular emergencies in order to keep ensuring a high level of health care to non-COVID-19 patients in northern Italy. In a few days, a COVID-19 emergency department was created, improving the general ward capacity to a total number of 279 beds dedicated to patients with COVID-19. Moreover, the number of intensive care unit (ICU) beds was increased from 28 to 72 (54 of them dedicated to patients with COVID-19, and 18 to cardiology and cardiac surgery hub emergencies), both converting pre-existing areas and creating new high technology spaces. All the involved health care personnel were rapidly trained to use personal protection equipment and to manage this particular category of patients both in general wards and ICUs. Furthermore, besides clinical activities, continuously important research projects were carried out in order to find new strategies and more effective therapies to better face an unprecedented health emergency in Italy. At our centre, after analysing the first trends of COVID-19 admissions, an expected demand for ward and ICU beds was estimated and a plan for gradual increase in ward and ICU capacity was set. This strategy was chosen because an immediate conversion of surgical and medical wards into dedicated and isolated COVID-19 wards and ICUs would have been impossible. A smoother transition translated into adequate staff training and reallocation and also facilitated moving or discharging non-COVID-19 patients from their original units without forcing discharges or inter-hospital transfers. For cardiovascular patients referred to the regional hub, a separate entrance was identified and a new ED area was created using outpatient clinics, while the original ED was dedicated to patients with COVID-19. Moreover, the intensive haematology bone marrow transplant and chimeric antigen receptor T cells (CAR-T) program was continued, with dedicated rescue ICU beds as recommended.