guidelines for managing hospital surge capacity

Accessed 10 June 2020. “Supporting the Health Care Workforce during the COVID-19 Global Epidemic.” JAMA. We then used these insights to evaluate the feasibility, in terms of capacity, of re-introducing elective surgery. NHS England. We estimated the absence rate of staff due to COVID-19 during this period from surveys of union members for nurses and doctors [19]. NHS England. 2 (2008): 114-18. https://doi.org/10.1097/DMP.0b013e31816c408b. Hospital provision interventions were assessed for their potential long-term feasibility based on official recommendations for the second phase of the NHS response to COVID-19 [4]. Their institutional affiliations are provided for purposes of identification only. Found insideMore than half of the 50 states had met or were close to meeting the criteria for the five medical-surge-related sentinel indicators for hospital capacity ... The baseline capacity of ventilators and other parameters in the model were derived from various sources (Additional file 2 [4, 9,10,11,12,13,14,15,16,17,18,19,20,21]). Google Scholar. Training in or working knowledge of key principles of public health ethics and disaster response is integral to preparation. NHS England. March 5, 2020. https://www.aamc.org/system/files/2020-03/Role%20of%20medical%20students%20and%20COVID-19-FINAL.pdf. Similar to previous mask mandates, masks can be removed at restaurants, bars and other eating/drinking establishments by patrons when they are actively eating/drinking while stationary. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, TRACIE. 2006. This period is most representative of what current capacity and occupancy would have been, without implementation of hospital provision interventions. Some clinicians frequently make care decisions across large populations. Guidance for Healthcare Ethics Committees. Accessed 10 June 2020. The challenge for healthcare planners now is planning capacity to treat non-COVID-19 conditions whilst maintaining the ability to respond to any potential future increases in demand for COVID-19 care. Bed Availability and Occupancy Data – Overnight. In England, a range of interventions has been implemented to increase hospital capacity in response to the pandemic. PC, JCD, AL, RM, NS, SN, PNG, ACG, NMF, PJW and KH acknowledge the MRC Centre for Global Infectious Disease Analysis (reference MR/R015600/1), jointly funded by the UK Medical Research Council (MRC) and the UK Foreign, Commonwealth and Development Office (FCDO), under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 programme supported by the European Union. An official website of the City of Chicago, Continue to distance and allow vulnerable residents to shelter, Haga clic aquí para ver la Guía de la Fase 5, Tracking cases, hospitalizations, ICU admissions, testing, and deaths across city and region, Monitoring cases over time by zip code, age, sex, race, and ethnicity (and direct resources where they are most needed), Shelters and housing for vulnerable populations, Food delivery and specific store times for senior citizens, Food security for CPS students and meals through Greater Chicago Food Depository. “Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2.” NAM Perspectives.Discussion paper. Hastings Center staff, in consultation with convening participants, produced a discussion tool and other publications for use by hospitals and regional health authorities. https://journals.lww.com/pccmjournal/Fulltext/2011/11001/Ethical_issues_in_pediatric_emergency_mass.9.aspx. Available from: https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2020/05/Statistical-commentary-April-2020-jf8hj.pdf. Available from: https://www.bbc.co.uk/news/live/world-52013888/page/2. Minnesota Department of Health. 2019. This is not drawn to scale. Whereas, under the staff-to-beds ratios, the spare capacity of both CC junior doctors and CC senior doctors can accommodate an extra 2120 patients and 11,175 CC patients respectively. Found inside – Page 1-204What other state or federal resources provide guidance for emergency management? The medical community is at the center of disaster and emergency planning. (i) In the surge phase (ii and iii), all elective surgery was assumed to be cancelled, freeing up beds for COVID-19 patients. Available from: https://www.rcplondon.ac.uk/projects/outputs/safe-medical-staffing. The full supply-side intervention package could accommodate up to 46,500 elective G&A patients requiring hospital care on a daily basis, and once G&A COVID-19 patients drop to below 7500 the increase in capacity from the set-up of field hospitals is equivalent to the full supply-side intervention package. Our analysis is conducted at the national level and thus does not consider the geographic distribution of hospital capacity, COVID-19 admissions and hospital utilisation patterns. As long as field hospitals remain operational, capacity is sufficient to meet pre-pandemic demand from all G&A patients regardless of the number of COVID-19 patients (Fig. The funding bodies had no role in the design of the study, analysis and interpretation of data and in writing the manuscript. Current transmission category level will be reflected above in the Reopening Dashboard. Executive Summary 4 2. Accessed 10 June 2020. Clinical ethics consultation (CEC) services, clinical ethics consultants, and ethics committees should recognize duties to promote equality of persons and equity in distribution of risks and benefits in society and consider how best to support clinical practice during a public health emergency. 2020. Privacy Stevens S, Pritchard A. For the post-surge phase, we estimated the number of elective patients who could be accommodated under decreasing numbers of COVID-19 patients, for different intervention scenarios. Found insideEstablishing Guidelines for Standards of Care During Disasters, ... on subjects related to hospital preparedness and response, surge capacity development, ... The future trajectory of demand for COVID-19 care is uncertain, making it necessary to reassess the planning of elective procedures frequently; this is facilitated with our planning tool [31]. Accessed 10 June 2020. Our work has a different complementary objective, as it assesses how to meet demand for COVID-19 care more broadly. These patients would be in addition to the current patient population on any day, and we assume the recommended staff-to-beds ratios are observed. NS also acknowledges funding from the Imperial College MRC Doctoral Training Partnership. Institute of Medicine. Our study demonstrates that English hospitals were successful in increasing capacity to deal with the surge in COVID-19 patients. In a public health emergency featuring severe respiratory illness, triage decisions may have to be made about level of care (ICU vs. medical ward); initiation of life-sustaining treatment (including CPR and ventilation support); withdrawal of life-sustaining treatment; and referral to palliative (comfort-focused) care if life-sustaining treatment will not be initiated or is withdrawn. One of the most impactful interventions for freeing up bed capacity was the cancellation of elective surgery in March 2020 [2], which led to a backlog of patients requiring care. This chart shows how we plan to return to work and life as well as protecting our health during each phase. Carbapenem-resistant Acinetobacter baumannii (CRAB), an opportunistic pathogen primarily associated with hospital-acquired infections, is an urgent public health threat (1).In health care facilities, CRAB readily contaminates the patient care environment and health care providers’ hands, survives for extended periods on dry surfaces, and can be spread by asymptomatically colonized … Additionally, under the observed peak number of COVID-19 patients, setting up of field hospitals and use of private hospitals each led to large increases of around 130% in spare G&A bed capacity compared with no interventions, and deployment of medical students increased spare capacity of G&A nurses and G&A junior doctors by 175% and 229%, respectively (Table 1). For our webinar for Hospital Ethics Committees and Clinical Ethics Consultation: https://www.thehastingscenter.org/guidancetoolsresourcescovid19/. Article  PA and AB conducted the data analysis of managing admission interventions. An ethically sound framework for health care organizations during public health emergencies acknowledges two competing sources of moral authority that must be held in balance: Clinicians, such as physicians and nurses, are trained to care for individuals. statement and “Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings.” February 18, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html. Various tools have been developed to make projections of demand for care [5,6,7,8], but they do not assess the extent to which interventions suffice to address population care needs. However, professionals often experience uncertainty or distress about how to proceed. An ethically sound framework for health care during public health emergencies must balance the patient-centered duty of care—the focus of clinical ethics under normal conditions—with public-focused duties to promote equality of persons and equity in distribution of risks and benefits in society—the focus of public health ethics. If this combination of interventions is not sustained, then this would only be possible for less than 320 COVID-19 patients in CC. Katharina Hauck. Accessed 10 June 2020. Because physicians, nurses, and other clinicians are trained to care for individuals, the shift from patient-centered practice to patient care guided by public health considerations creates great tension, especially for clinicians unaccustomed to working under emergency conditions with scarce resources. a Timeline of the phases considered in the analysis. Health care institutions that employ trainees, such as medical students and nursing students, should recognize these workers as a vulnerable population.Â, The Duty to Guide:Contingency Levels of Care and Crisis Standards of Care. Adams and R. M. Walls. Goal is to limit interactions to rapidly slow the spread of COVID-19, WORKEssential workers go to work; everyone else works from homeLIFEStay at home and limit going out to essential activities only, HEALTHPhysically distance from anyone you do not live with, especially vulnerable friends and family, Goal is to continue flattening the curve while safely being outside, (Guard against unsafe interactions with others), WORK Essential workers go to work; everyone else works from home, HEALTH Wear a face covering while outside your home, Physically distance from anyone you do not live with, especially vulnerable friends and family, Goal is to thoughtfully begin to reopen Chicago safely, Strict physical distancing with some businesses reopening, WORK Non-essential workers begin to return to work in a phased way, Select businesses, non-profits, city entities open with demonstrated, appropriate protections for workers and customers, LIFE When meeting others, physically distance and wear a face covering, Non-business, social gatherings limited to ≤10 persons, Phased, limited public amenities begin to open​, HEALTH Stay at home if you feel ill or have come into contact with someone with COVID-19, Continue to physically distance from vulnerable populations, Goal is to further reopen Chicago while ensuring the safety of residents, Continued staggered reopening into a new normal, WORK Additional business and capacity restrictions are lifted with appropriate safeguards, Continue to wear a face covering and physically distance, HEALTH Continue to distance and allow vulnerable residents to shelter, Get tested if you have symptoms or think you have had COVID-19, Goal is to continue to maintain safety until COVID-19 is contained, Continue to protect vulnerable populations, Non-vulnerable individuals can resume working, LIFE Most activities resume with health safety in place. World Health Organization. Interventions implemented in England during the surge phase were previously identified [24] through a review of NHS sources, the European Observatory’s Health System Response Monitor [25] as well as the public press and were included in the model if they could be quantified at a national level. Model input values, assumptions, references to data sources and how inputs were quantified for the purpose of this analysis. The expected impact of each intervention across all resources was calculated as percentage changes of the baseline based on an analysis of NHS England data [26, 27] and from various sources [28,29,30] (Additional file 3). Therefore, the daily number of G&A elective patients was varied in bands of 500, and the equivalent value for CC derived via this relationship. A severe respiratory illness such as COVID-19 can require ventilator or ECMO support for critically ill patients in an intensive care unit, with ongoing monitoring by respiratory technicians and critical-care nurses. The maximum number of COVID-19 patients that could be accommodated by each resource under different scenarios, namely, no interventions, each individual intervention and the combination of hospital provision interventions that was implemented (herein referred to as the implemented intervention package), was determined. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The objectives of this study are threefold: first, to estimate available hospital capacity for emergency treatment of COVID-19 and other patients during the surge phase of the epidemic in England (March and April 2020); second, to evaluate the increase in capacity achieved via five hospital provision interventions (cancellation of elective surgery, set-up of field hospitals, use of private hospitals, deployment of former healthcare staff and deployment of newly qualified and final year nursing and medical students) during the surge phase; and third, to determine how to conduct elective surgery at pre-pandemic levels considering continued demand from COVID-19 patients during the post-surge phase. Moscelli G, Siciliani L, Tonei V. Do waiting times affect health outcomes? processes and practices for institutional services; see Guidelines below. Part of BMC Med 18, 329 (2020). At this point, the number of hospitalised COVID-19 cases has been observed to gradually decline, and hospitals have considered how to safely provide care again for all patients requiring it, whilst also planning for possible future surges in COVID-19 case numbers. KH and PJW provided guidance on the interpretation of the findings and contributed to the writing of the report. We developed a model to quantify hospital capacity for general and acute and critical care considering three crucial resources: staff, beds and ventilators. Report brief. The 2006 convening and publications were made possible by a grant from the Providence St. Vincent Medical Foundation. Available from: https://www.health.org.uk/news-and-comment/charts-and-infographics/covid-19-policy-tracker. Accessed 10 June 2020. We examined potential approaches to enabling resumption of elective surgery in the post-surge phase. Public health practice aims to promote the health of the population by minimizing morbidity and mortality through the prudent use of resources and strategies. All authors reviewed the final draft. Institute of Medicine. Found inside – Page 482... 212 Hospital Command Center ( HCC ) , 210 hospital surge capacity ... 208t wound management guidelines , 208t shelter refugee medical care in , 212-213 ... Michigan Department of Community Health, Office of Public Health Preparedness. Available from: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/04/second-phase-of-nhs-response-to-covid-19-letter-to-chief-execs-29-april-2020.pdf. 3a). Cases involving patients with life-threatening illness, including those who lack capacity to make decisions concerning life-sustaining interventions and other medical treatment, often give rise to uncertainty. E. L. D. Biddison et al. Even before any COVID cases have been detected nationally, it is critical to prepare for the possibility of increasing transmission and plan for surge COVID-19 testing capacity. The state, which saw a surge of cases in fall 2020 but has since stabilized, is in Phase 2 of its reopening and most hotels, bars, restaurants and other businesses are open; capacity restrictions and 10 p.m. closures were lifted in January 2021. A&E Attendances and Emergency Admissions April 2020 Statistical Commentary. The duties of health care leaders to clinicians and community during a public health emergency can be expressed as follows: to plan, to safeguard, to guide. BBC News. In a public health emergency, first responders need clear rules to follow. For example, converting 474 G&A beds to CC beds and upskilling 359 G&A nurses to CC nurses would have overcome this deficit. Centers for Disease Prevention and Control. In the post-surge phase (iv), reductions in numbers of COVID-19 patients enables some elective surgery to resume, with the numbers of such patients who can be accommodated depending on the extent to which other interventions are maintained. Crisis Standards of Care: Lessons from Communities Building Their Plans: Workshop in Brief. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforce-statistics/december-2019. [1,2] Overcrowding of EDs is defined as “the situation in which ED function is impeded primarily because of the excessive number of patients waiting to be seen, undergoing assessment and treatment, or waiting for departure comparing … COVID-19Surge is a spreadsheet-based tool that hospital administrators and public health officials can use to estimate the surge in demand for hospital-based services during the COVID-19 pandemic. The following authors were part of the Imperial College London Hospital Capacity Planning Group: Ruth McCabe, Nora Schmit, Paula Christen, Josh C. D’Aeth, Alessandra Løchen, Dheeya Rizmie. These rates were coupled with baseline absence rates, to calculate the number of available staff during the surge. Found inside – Page 2518 ASPR's 2007 Hospital Preparedness Program guidance specifically authorized ... The medical surge capability includes activities and critical tasks needed ... https://doi.org/10.1017/S1049023X0000683X. Accessed 10 June 2020. JCD, RM and NS conducted the analysis. 1b). Whilst we estimate a small deficit in CC beds, CC nurses and CC junior doctors at the time of the peak number of hospitalised COVID-19 patients, additional interventions which could not be quantified at the national level could have been used. Available from: https://www.england.nhs.uk/2020/03/nhs-strikes-major-deal-to-expand-hospital-capacity-to-battle-coronavirus/. Accessed 10 June 2020. Combining the interventions as parameterised in Table 2 provides an illustration of true capacity within NHS England during the surge phase. NMF and KH were also supported by the National Institute for Health Research (NIHR) HPRU in Modelling and Health Economics, a partnership between Public Health England (PHE), Imperial College London and LSHTM (grant code NIHR200908). Maximum daily number of COVID-19 patients that could be accommodated by different CC (a) and G&A (b) resources with and without hospital provision interventions. HHS is primarily responsible for supporting laboratory capacity and diagnostic testing to provide rapid confirmation of cases, as well as for creating the mechanisms for clinical surveillance in acute care settings and keeping public health officials aware of the epidemiological profile and spread of the illness. The federal National Strategy for Pandemic Influenza,[1] its detailed Implementation Strategy,[2] and the Department of Health and Human Services (HHS) Pandemic Influenza Plan[3] describe the roles and responsibilities of the federal, state, and local authorities before, during, and after infectious disease outbreaks. November 2012. https://www.mimedicalethics.org/Documentation/Michigan%20DCH%20Ethical%20Scarce%20Resources%20Guidelines%20v2%20rev%20Nov%202012.0.pdf. Finally, the post-surge phase began in May 2020. The assessment of whether there is elevated risk of local transmission is made on current evidence and takes into account a lag time of 7-14 days before any impact of additional measures will be seen on numbers of cases, and health system use. All analysis was undertaken on R and is available publicly on Github.Footnote 1. In Phase 5, most mandatory COVID-19 regulations have been lifted, including capacity limits and social distancing requirements at most businesses. Given estimates of baseline capacity in the absence of hospital provision interventions, and when factoring in COVID-19 related staff absence rates, up to 327 and 9769 COVID-19 patients could have been accommodated in CC and G&A care, respectively (Fig. Veterans Health Administration’s National Center for Ethics in Health Care, Pandemic Influenza Ethics Initiative Work Group. The observed peak number of hospitalised patients with confirmed COVID-19 recorded (as of 31 May 2020) was set as the maximum number of COVID-19 patients in this analysis [4, 23]. Public health ethics guides us in balancing this tension between the needs of the individual and those of the group. U.S. Department of Health and Human Services. institutional and health system policies concerning coordination with public health authorities responsible for surveillance, reporting, quarantine, and resource allocation from federal and state stockpiles (see. Ventilator Challenge hailed a success as UK production finishes. The relationship between the daily bed occupancy of hospitalised COVID-19 patients and beds available for hospitalised elective patients on an average day under different combinations of hospital provision interventions for a CC beds and b G&A beds. For the most comprehensive daily COVID-19 data, please see the Daily COVID-19 Dashboard at chi.gov/coviddash. Available from. Available from: https://penn-chime.phl.io/. For example, there may be adequate numbers of ventilators but not enough trained respiratory technicians and critical care personnel to use them. July 1, 2011. https://www.cdc.gov/about/advisory/pdf/VentDocument_Release.pdf. Washington, DC: National Academies Press, 2014. https://www.nationalacademies.org/hmd/Activities/PublicHealth/MedPrep/2014-APR-02/Workshop-in-Brief.aspx. Complementary objective, as well as protecting our health during each phase capacity by reducing collections to a and! 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