Managing Hospital Capacity: Achievements and Lessons from the COVID-19 Pandemic

Abstract Introduction: The coronavirus disease 2019 (COVID-19) pandemic challenged health care systems in an unprecedented way. Due to the enormous amount of hospital ward and intensive care unit (ICU) admissions, regular care came to a standstill, thereby overcrowding ICUs and endangering (regular and COVID-19-related) critical care. Acute care coordination centers were set up to safely manage the influx of COVID-19 patients. Furthermore, treatments requiring ICU surveillance were postponed leading to increased waiting lists. Hypothesis: A coordination center organizing patient transfers and admissions could reduce overcrowding and optimize in-hospital capacity. Methods: The acute lack of hospital capacity urged the region West-Netherlands to form a new regional system for patient triage and transfer: the Regional Capacity and Patient Transfer Service (RCPS). By combining hospital capacity data and a new method of triage and transfer, the RCPS was able to effectively select patients for transfer to other hospitals within the region or, in close collaboration with the National Capacity and Patient Transfer Service (LCPS), transfer patients to hospitals in other regions within the Netherlands. Results: From March 2020 through December 2021 (22 months), the RCPS West-Netherlands was requested to transfer 2,434 COVID-19 patients. After adequate triage, 1,720 patients with a mean age of 62 (SD = 13) years were transferred with the help of the RCPS West-Netherlands. This concerned 1,166 ward patients (68%) and 554 ICU patients (32%). Overcrowded hospitals were relieved by transferring these patients to hospitals with higher capacity. Conclusion: The health care system in the region West-Netherlands benefitted from the RCPS for both ward and ICU occupation. Due to the coordination by the RCPS, regional ICU occupation never exceeded the maximal ICU capacity, and therefore patients in need for acute direct care could always be admitted at the ICU. The presented method can be useful in reducing the waiting lists caused by the delayed care and for coordination and transfer of patients with new variants or other infectious diseases in the future.

[1]  H. Salehiniya,et al.  Impact of the COVID-19 Pandemic on Colorectal Cancer Diagnosis and Treatment: a Systematic Review , 2021, Journal of Gastrointestinal Cancer.

[2]  C. Lamas Oliveira,et al.  Hospital capacity and admission rate may be a factor of importance to mortality in COVID-19. , 2021, Infectious diseases.

[3]  S. Walther,et al.  Mortality in hospitalized COVID-19 patients was associated with the COVID-19 admission rate during the first year of the pandemic in Sweden , 2021, Infectious diseases.

[4]  G. Montanari Vergallo,et al.  COVID-19: when health care resources run short, how to pick who should (not) get treated? , 2021, Acta bio-medica : Atenei Parmensis.

[5]  D. Smithard,et al.  COVID-19 Pandemic Healthcare Resource Allocation, Age and Frailty , 2021, The New bioethics : a multidisciplinary journal of biotechnology and the body.

[6]  D. Atsma,et al.  Home monitoring reduced short stay admissions in suspected COVID-19 patients: COVID-box project , 2021, European Respiratory Journal.

[7]  Lesly A. Dossett,et al.  T-Minus 10 Days: The Role of an Academic Medical Institution in Field Hospital Planning , 2021, Prehospital and Disaster Medicine.

[8]  M. Schalij,et al.  Prehospital triage of patients with acute cardiac complaints: study protocol of HART-c, a multicentre prospective study , 2021, BMJ Open.

[9]  P. Barach,et al.  Population Health Strategies to Support Hospital and Intensive Care Unit Resiliency During the COVID-19 Pandemic: The Italian Experience. , 2020, Population health management.

[10]  A. Giannini Who gets the last bed? Ethics criteria for scarce resource allocation in the era of Covid-19. , 2020, Minerva anestesiologica.

[11]  Zihui Tan,et al.  Practical Considerations for Converting Operating Rooms and Post-anaesthesia Care Units into Intensive Care Units in the COVID-19 Pandemic - Experience from a Large Singapore Tertiary Hospital. , 2020, Annals of the Academy of Medicine, Singapore.

[12]  M. Kramer,et al.  Experience of the Coronavirus Disease (COVID-19) Patient Care in the Amsterdam Region: Optimization of Acute Care Organization , 2020, Disaster Medicine and Public Health Preparedness.

[13]  David F.M. Brown,et al.  The cases not seen: Patterns of emergency department visits and procedures in the era of COVID-19 , 2020, The American Journal of Emergency Medicine.

[14]  M. Schalij,et al.  Emergency medical services evaluations for chest pain during first COVID-19 lockdown in Hollands-Midden, the Netherlands , 2020, Netherlands Heart Journal.

[15]  A. Bitencourt,et al.  Ethical dilemmas in COVID-19 times: how to decide who lives and who dies? , 2020, Revista da Associacao Medica Brasileira.

[16]  P. Barie,et al.  Rapid Critical Care Training of Nurses in the Surge Response to the Coronavirus Pandemic. , 2020, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[17]  S. Memtsoudis,et al.  Cancellation of Elective Surgery and Intensive Care Unit Capacity in New York State: A Retrospective Cohort Analysis , 2020, Anesthesia and analgesia.

[18]  O. Fersia,et al.  The impact of the COVID-19 pandemic on cardiology services , 2020, Open Heart.

[19]  Y. Mahjoub,et al.  French ICUs fight back: An example of regional ICU organisation to tackle the SARS-CoV-2 outbreak , 2020, Anaesthesia Critical Care & Pain Medicine.

[20]  Yunpeng Ji,et al.  Potential association between COVID-19 mortality and health-care resource availability , 2020, The Lancet Global Health.

[21]  Mark Britnell Human: Solving the global workforce crisis in healthcare , 2019 .

[22]  N. Kissoon,et al.  Surge capacity principles: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. , 2014, Chest.

[23]  C. Sprung,et al.  Recommendations for intensive care unit and hospital preparations for an influenza epidemic or mass disaster: summary report of the European Society of Intensive Care Medicine’s Task Force for intensive care unit triage during an influenza epidemic or mass disaster , 2010, Intensive Care Medicine.

[24]  J. Broadhead,et al.  WHO consensus statement. , 1990, The British journal of psychiatry : the journal of mental science.

[25]  Bruria Adini,et al.  Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster , 2010, Intensive Care Medicine.