Hospital Surge Capacity during Expo 2015 in Milano, Italy

Faccincani, Roberto; Corte, Francesco Della; Sesana, Giovanni; Stucchi, Riccardo; Weinstein, Eric S.; Ashkenazi, Itamar; Ingrassia, Pier Luigi

doi:10.1017/s1049023x18000742

Cited by 16 publications

(18 citation statements)

References 35 publications

(33 reference statements)

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“…As this pandemic is ongoing, surge capacity models that allow some flexibility may be the most useful [7,9,19]. Hospital capacity is dynamic and highly dependent on the occupancy of available resources [20]. When the pressure on ED care is lower, capacity could be used for non-urgent care and vice versa.…”

Section: Plos Onementioning

confidence: 99%

Preparations of Dutch emergency departments for the COVID-19 pandemic: A questionnaire-based study

2021

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Background The onset of the COVID-19 pandemic was characterized by rapid increases in Emergency department (ED) patient visits. EDs required an appropriate transformation. The main challenges were: adapting capacity to respond to surges in the number of patient visits, protection of high risk (frontline) staff and the segregation of suspect-COVID-19 patients. To date, only a few studies have assessed the nation-wide response of EDs to the COVID-19 pandemic. This study was designed to review the preparations of Dutch EDs during the initial phase of this public health crisis. Methods The study was designed as a nation-wide, cross-sectional, questionnaire-based study of Dutch hospital organizations having one or more EDs. One respondent completed the questionnaire for each hospital. The questionnaire was conducted between the first and the second COVID-19 wave in the Netherlands. It contained close-ended and open-ended questions on changes in ED infrastructure, ED workforce adaptions and the role of emergency physicians (EPs) in each hospital crisis management team. Results The questionnaire was completed by 58 respondents. This represented 80% of the total number of EDs. All respondents had made preparations in anticipation of a COVID-19 patient surge. Treatment capacity was expanded in 70% of EDs, with a median increase of 49% (IQR 33–73%). Suspect-COVID-19 was segregated from non-COVID-19 patients in 89% of EDs. Alternative locations (such as outpatient departments) were more often used to assess non-COVID-19 patients, than for suspect-COVID-19 patients. Staff was expanded in 82% of EDs. This largely concerned nursing staff. A formal role for Emergency Physicians (EPs) in the hospital’s crisis management team was reported by 94% of hospital organizations employing EPs. Conclusion All Dutch EDs responded to the COVID-19 pandemic in a very short time span despite much uncertainty. Preparations predominantly concerned expansion of treatment capacity and segregation of COVID-19 ED care. EPs played a prominent role, both in direct COVID-19 care and in the hospital crises management team. It is vital for EDs to adapt to community needs swiftly. The ability of EDs to respond to the pandemic varied considerably.

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Section: Plos Onementioning

confidence: 99%

Preparations of Dutch emergency departments for the COVID-19 pandemic: A questionnaire-based study

2021

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“…7,9,18 Hospital capacity is dynamic and highly dependent on the occupancy of available resources. 19 At times when the pressure on ED care is temporarily lower, capacity could be used for non-urgent care and vice versa. This way, hospitals could timely anticipate to community demands.…”

Section: Discussionmentioning

confidence: 99%

Preparations of Dutch emergency departments for the COVID-19 pandemic: a questionnaire-based study

Connor

Barten

Latten

2021

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Background: The onset of the COVID-19 pandemic was characterized by rapidly increasing patient volumes, which necessitated a swift emergency department (ED) overhaul. Challenges mainly concerned surge capacity, frontline staff protection and the segregation of patients with suspected COVID-19. To date, only few studies have assessed nation-wide ED preparedness for the COVID-19 pandemic. This study aimed to form an overview of preparations that were taken in Dutch EDs during the initial phase of this public health crisis. Methods: This study was designed as a nation-wide, cross-sectional, questionnaire-based study among Dutch hospital organizations with an ED. The questionnaire was conducted between the first and the second wave of the COVID-19 pandemic in the Netherlands and contained close-ended and open-ended questions on changes in ED infrastructure, ED workforce adaptions and the role of emergency physicians (EPs) in the hospital crisis organizations. Results: Overall response rate was 79.5%. All EDs had made preparations in anticipation of a possible COVID-19 surge. Treatment capacity was expanded in 69.7% of EDs, with a median increase of 49% (IQR 32.5-72.7%). COVID-19 suspected patients were segregated from non-COVID-19 patients in 86.4% of EDs. Non-COVID-19 patients were more often assessed at alternative locations than patients with suspected COVID-19 infection. In 81.8% of EDs the workforce was expanded, which mainly concerned expansion of nursing staff. A formal role of EPs in the hospital crisis organizations was reported by 93.9% of EP staffed hospital organizations. Conclusion: All Dutch EDs made preparations for COVID-19 in a short time span and with many uncertainties. Preparations predominantly concerned expansion of treatment capacity and segregation of COVID-19 ED care. EPs had a prominent role, both in direct patient COVID-19 ED care and in the hospital crisis organizations. Although it is vital for EDs to be able to dynamically adapt to community needs, variability of pandemic ED preparedness was high.

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“…It has to be noticed also that modelling the resources to be mobilized in case of PEMAF activation only the specialized trauma staff has been considered: this makes a lot of sense considering how in case of a MCI this is the most significant limiting factor to actual as well as surge capacity. 55 Despite this it cannot be silenced that other bottlenecks should be considered: even remaining in the staff domain we have to mention the support personnel (porters); the flow of patients from the ED gate to the final destination cannot of course exist without staff who care the transport. But we could as well mention many other well-known bottlenecks under the "stuff" domain, like ventilators,…”

Section: Discussionmentioning

confidence: 99%

“…The rate of bed occupation is close to 90% for the surgical wards, 75% for the medical ones. OSR was selected for this study because it was previously involved in researches in the topic of hospital preparedness and management of MCI, 55 in particular related to the EU funded project THREATS (Terrorist attacks on Hospitals: Risk and Emergency Assessment, Tools and Systems. HOME/2013/CIPS/AG/4000005056) 56 and has developed a robust experience in this field.…”

Section: Introductionmentioning

confidence: 99%

RETRACTED–Assessing Hospital Adaptive Resource Allocation Strategies in Responding to Mass Casualty Incidents

Faccincani

Trucco

Nocetti

et al. 2021

Disaster med. public health prep.

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Background: Hospitals are expected to operate at a high performance level even under exceptional conditions of peak demand and resource disruptions. This understanding is not mature yet and there are wide areas of possible improvement. In particular, the fast mobilization and reconfiguration of resources frequently result into the severe disruption of elective activities, worsening the quality of care. This becomes particularly evident during the on-going coronavirus disease 2019 (COVID-19) pandemic. More resilient resource allocation strategies, that is, which adapt to the dynamics of the prevailing circumstance, are needed to maximize the effectiveness of health-care delivery. In this study, a simulation approach was adopted to assess and compare different hospital’s adaptive resource allocation strategies in responding to a sudden onset disaster mass casualty incident (MCI). Methods: A specific set of performance metrics was developed to take into consideration multiple objectives and priorities and holistically assess the effectiveness of health-care delivery when coping with an MCI event. Discrete event simulation (DES) and system dynamics (SD) were used to model the key hospital processes and the MCI plan. Results: In the daytime scenario, during the recovery phase of the disaster, a gradual disengagement of resources from the emergency department (ED) to restart ordinary activities in operating rooms and wards returned the best performance. In the night scenario, the absorption capacity of the ED was evaluated by identifying the current bottleneck and assessment of the benefit of different resource mobilization strategies. Conclusions: The present study offers a robust approach, effective strategies and new insights to design more resilient plans to cope with MCIs. It becomes particularly relevant when considering the risk of indirect damage of emergencies, where all the available resources are shifted from the care of the ordinary to the “disaster” patients, like during the on-going COVID-19 pandemic. Future research is needed to widen the scope of the analysis and take into consideration additional resilience capacities such as operational coordination mechanisms among multiple hospitals in the same geographic area.

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Hospital Surge Capacity during Expo 2015 in Milano, Italy

Cited by 16 publications

References 35 publications

Preparations of Dutch emergency departments for the COVID-19 pandemic: A questionnaire-based study

Preparations of Dutch emergency departments for the COVID-19 pandemic: A questionnaire-based study

Preparations of Dutch emergency departments for the COVID-19 pandemic: a questionnaire-based study

RETRACTED–Assessing Hospital Adaptive Resource Allocation Strategies in Responding to Mass Casualty Incidents

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