Adapting hospital capacity to meet changing demands during the COVID-19 pandemic

BMC Medicine

Marisa Miraldo¹  Dheeya Rizmie¹  Alex Bottle²  Paul Aylin³  Shevanthi Nayagam⁴  Ruth McCabe⁴  Paula Christen⁴  Azra C. Ghani⁴  Alessandra Løchen⁴  Nora Schmit⁴  Josh C. D’Aeth⁴  Pablo N. Perez-Guzman⁴  Peter J. White⁵  Neil M. Ferguson⁶  Katharina Hauck⁶ 

[1] Centre for Health Economics & Policy Innovation, Department of Economics & Public Policy, Imperial College Business School, Imperial College London, London, UK;Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London, London, UK;Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London, London, UK;NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK;MRC Centre for Global Infectious Disease Analysis and Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, Norfolk Place, W2 1PG, London, UK;MRC Centre for Global Infectious Disease Analysis and Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, Norfolk Place, W2 1PG, London, UK;Modelling and Economics Unit, National Infection Service, Public Health England, London, UK;MRC Centre for Global Infectious Disease Analysis and Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, Norfolk Place, W2 1PG, London, UK;NIHR Health Protection Research Unit in Modelling and Health Economics, Imperial College London, London, UK;

关键词: Hospital capacity;    Interventions;    General & acute;    Critical care;    Elective surgery;    COVID-19;   

DOI  :  10.1186/s12916-020-01781-w

来源: Springer

【 摘 要 】

BackgroundTo calculate hospital surge capacity, achieved via hospital provision interventions implemented for the emergency treatment of coronavirus disease 2019 (COVID-19) and other patients through March to May 2020; to evaluate the conditions for admitting patients for elective surgery under varying admission levels of COVID-19 patients.MethodsWe analysed National Health Service (NHS) datasets and literature reviews to estimate hospital care capacity before the pandemic (pre-pandemic baseline) and to quantify the impact of interventions (cancellation of elective surgery, field hospitals, use of private hospitals, deployment of former medical staff and deployment of newly qualified medical staff) for treatment of adult COVID-19 patients, focusing on general and acute (G&A) and critical care (CC) beds, staff and ventilators.ResultsNHS England would not have had sufficient capacity to treat all COVID-19 and other patients in March and April 2020 without the hospital provision interventions, which alleviated significant shortfalls in CC nurses, CC and G&A beds and CC junior doctors. All elective surgery can be conducted at normal pre-pandemic levels provided the other interventions are sustained, but only if the daily number of COVID-19 patients occupying CC beds is not greater than 1550 in the whole of England. If the other interventions are not maintained, then elective surgery can only be conducted if the number of COVID-19 patients occupying CC beds is not greater than 320. However, there is greater national capacity to treat G&A patients: without interventions, it takes almost 10,000 G&A COVID-19 patients before any G&A elective patients would be unable to be accommodated.ConclusionsUnless COVID-19 hospitalisations drop to low levels, there is a continued need to enhance critical care capacity in England with field hospitals, use of private hospitals or deployment of former and newly qualified medical staff to allow some or all elective surgery to take place.

【 授权许可】

CC BY