Teams across Mass General Brigham (MGB) and the Brigham have been planning to ensure we can effectively and safely care for patients during a surge. Our plans address how we will adjust our operations when patient levels reach 25 percent, 50 percent or 100 percent of our peak patient level during the initial surge — which at the Brigham was 197 inpatients.

This week, Jesslyn Lenox, MHA, RRT-NPS, AE-C, director of Pulmonary Services, and Brian Yorko, executive director of Inpatient and Clinical Services, share details about our plans for Respiratory Therapy (RT).

What are you anticipating will be the key challenges for Respiratory Therapy in a second surge? 

Jesslyn Lenox and Brian Yorko

Yorko: We anticipate that the No. 1 challenge for RT in this surge, like many patient care areas, will be staffing. The acuity level of ventilated COVID-19 patients is quite high. These patients require extra attention and time from our staff. At the same time, we expect to experience normal turnover and staff who are out due to illness. We need to make sure we have enough staff to safely care for our patients.

Lenox: To address this issue, we have proactively brought in travelers. There is a tremendous amount of competition for this staff, especially around the holidays. RT leadership evaluates our staffing situation daily and adjusts, as needed, to ensure patient needs are safety met.

What are the most important things all Brigham staff should know about the second surge plan for Respiratory Therapy?

Lenox: We have learned a tremendous amount this year about the impact this virus has on the lungs. That experience is helping us better manage patients that require ventilators. We have high confidence in our overall supplies, including our supply of mechanical ventilators. Thanks to collaboration at the MGB level, we have purchased dozens of new ICU ventilators for use across the system.

We have also seen evidence that providing noninvasive support, such as high-flow nasal cannula (HFNC) can potentially prevent 50 percent of the intermediate COVID patient population from requiring intubation and mechanical ventilation. This knowledge allows us to change our patient management strategy as appropriate.

Yorko: Interdisciplinary teamwork was key to the successful management of COVID patients in the initial surge, and it will be again this time around. RT will collaborate with nurse anesthetists, anesthesia, nursing, perfusion, as well as our physical therapy colleagues (to name a few!) to provide the best possible patient care in the intense environment of this second surge.