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Fig. 1 | Annals of Intensive Care

Fig. 1

From: The resilient intensive care unit

Fig. 1

Resilience in Intensive Care Units. In A, we show the proposed framework of evaluating the resiliency of an ICU, based on the four pillars of Hollnagel’s Resilience Assessment Grid (Respond, Learn, Anticipate, and Monitor) and the 4 S (Staff, stuff, space, systems). A resilient ICU should respond to sudden periods of crisis with adequate management of its resources, including the staff wellness and leadership, to provide improved outcomes. Resilience should be maintained by continuously monitoring ICU data (increased volumes, case-mix changes, and outcomes), the learning process based on science, evidence-based practices, clinical research, and effective communication. Finally, a resilient ICU must be prepared to maintain health services outcomes during surge periods with adequate staff training, management of processes of care and ICU resources, thus reducing the impact on clinical and staff outcomes. We show two examples of ICUs resilience expected behaviors, comparing the dynamics of mortality of non-COVID-19 patients (measured in Variable-Life Adjustment Display—VLAD) and the surge of COVID-19 admissions from January to December 2020: the high resilience ICU B shows a steady progression of mortality in non-COVID-19 cases during the pandemic period; whereas in the low resilient ICU C the mortality of non-COVID-19 patients shows high variability, with a decrease in VLAD in the COVID-19 surge peak

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