Challenges and navigating conundrums in setting up an obstetrics and gynecology coronavirus disease facility in a pre-existing tertiary care hospital – An Indian perspective

Abstract

India at present has 145,779 active coronavirus disease (COVID) cases and 8884 deaths. Being the largest tertiary care health facility under Delhi Government, our center was designated as a 2000 bedded dedicated COVID hospital. In addition to establishing areas for COVID management, COVID Obstetrics and Gynecology area requires a dedicated set up for delivering women, an operating room, and a neonatal care unit. A phased evacuation plan begins by curtailing non-emergency services and postponing elective surgeries, this process may take longer for obstetrics than other specialties on account of labor and postnatal care. The percentage reduction in the number of elective obstetric and gynecological surgeries was 73% and further fell by 98% (n = 4; category C, D) over a period of 1 month of the evacuation phase, whereas the reduction in emergency cases was only 15% (n = 200) in the beginning and fell to 89%. During the surge phase of COVID, we were able to increase the inpatient surge capacity by 8% (n = 100) as the bed occupancy increased exponentially from 30% to 88%. The start of evacuation of the facility until the endpoint of the surge marks the most dynamic phase of establishing a COVID facility during a pandemic. Pre-event planning for surge capacity at the inception of such pandemics should be based on the local and regional policies which depend on the competing demands of resources to maintain sustainability. These logistical demands are dynamic and vary as the pandemic progresses through its phases.

Barriers in Accessing Emergency Obstetric Service: A Prospective Observational Study at a Tertiary Care Centre

“…Level 2 delay in our study was most commonly due to being declined at a previous center. During the pandemic, many hospitals in our city (both private and public sector) were converted into COVID hospitals and their obstetric facilities were shut down (Dhiman et al,2021). Although the inpatients in these hospitals at the time of conversion were referred to other hospitals, the pregnant women booked/registered at these centers were neither guided appropriately, nor a linkage was established with other centers.…”

“…Unfortunately, many women had a delay in being attended in the casualty due to overcrowding. There was a shortage of manpower as many healthcare professionals were suffering from the infection (Dhiman et al,2021). A meta-analysis on level 3 delay in developing countries (Knight et al, 2013) revealed various barriers in care: skilled health professionals (86%), availability of drugs/ other components (65%), staff shortages (60%), and low staff motivation (44%).…”

Characteristics of outpatient gynecology oncology services before and after COVID-19 pandemic at Ulin Regional General Hospital, Banjarmasin, Indonesia

“…These SOPs should allow for swift revisions, if warranted, within a 3-4week timeframe to effectively respond to evolving pandemic dynamics. 14 The preparedness evaluation for health facilities embraces multiple facets, including the availability of personal protective equipment (PPE), functional blood banks, proficient surgical teams, nursing support, sterile equipment, room capacity, negatively pressurized operating rooms, specialized treatment spaces, and prompt emergency management. Effective scheduling, in accordance to available resources and individual patient needs, must be orchestrated across the hospital system to ensure patient-specific care.…”