Setting up hospital care provision to patients with COVID-19: lessons learnt at a 2400-bed academic tertiary center in São Paulo, Brazil

Abstract

As of August 30, 2020, Brazil ranked second among countries with the highest number of COVID-19 cases, with the city of São Paulo as the national epidemic epicenter. Local public healthcare institutions were challenged to respond to a fast-growing hospital demand, reengineering care provision to optimize clinical outcomes and minimize intra-hospital coronavirus infection. In this paper we describe how the largest public hospital complex in Latin America faced this unprecedented burden, managing severe COVID-19 cases while sustaining specialized care to patients with other conditions. In our strategic plan a 900-bed hospital was exclusively designated for COVID-19 care and continuity of care to those not infected with coronavirus ensured in other inpatient facilities. After 152 days, 4241 patients with severe COVID-19 were hospitalized, 70% of whom have already been discharged, whereas the remaining Institutes of the complex successfully maintained high complexity inpatient and urgent/emergency care to non-COVID-19 patients.

Unraveling COVID-19-related hospital costs: The impact of clinical and demographic conditions

“…So, regulators transferred critically ill COVID-19 patients and those with complex underlying conditions requiring specialized care to HCFMUSP, where the ICU capacity was increased. [5, 6] As expected, in our study, the highest cost/day was incurred during the ICU stay.…”

“…The Central Institute of HCFMUSP, with 900 beds, including 300 ICU beds, 206 of which were newly installed in response to this pandemic, was entirely dedicated to COVID-19 patients referred for admission, and has delivered tertiary hospital care for more than 4,000 severe COVID-19 cases. [5][6][7] The centralization of care in a single institute provided a unique opportunity for a precise and homogeneous economic evaluation of these admissions. The aim of this study was to describe the direct and fixed hospital costs related to the treatment of hospitalized patients with COVID-19, as well as the main cost components and related clinical factors.…”

Geo-environmental parametric 3D models of SARS-CoV-2 virus circulation in hospital ventilation systems

“…Some of these hospitals were existing structures prior to the pandemic, whereas others are being constructed from the ground up in real time to deal with the massive, to cater to the rapid influx of patients. Modular structures have been utilized in many instances due to the shorter construction time required, given the urgency imposed by the pandemic ( Perondi et al, 2020 , Chen et al, 2021 , Yang and Chong, 2021 ). One Brazilian example of this was the construction of the Independência Hospital in the State of Rio Grande do Sul’s capital city, Porto Alegre, a structure built using modules and dedicated only to the treatment of COVID-19 patients.…”

Post-acute sequelae of SARS-CoV-2 infection (PASC): a protocol for a multidisciplinary prospective observational evaluation of a cohort of patients surviving hospitalisation in Sao Paulo, Brazil

“…During the 2020 COVID-19 outbreak, our largest public-funded academic health centre (Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo; HCFMUSP) undertook an operation that turned its main hospital into a fully dedicated inpatient facility for individuals presenting moderate to severe COVID-19. 13 A total of 900 beds were made available at this site, more than 300 of which in intensive care units (ICUs). Over 3500 inpatient admissions due to suspected SARS-CoV-2 infection took place from 30 th March through August 2020.…”