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

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Title: Adapting hospital capacity to meet changing demands during the COVID-19 pandemic
Authors: McCabe, R
Schmit, N
Christen, P
D'Aeth, J
Løchen, A
Rizmie, D
Nayagam, AS
Miraldo, M
Aylin, P
Bottle, R
Perez-Guzman, PN
Ghani, A
Ferguson, N
White, P
Hauck, K
Item Type: Journal Article
Abstract: Background To 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. Methods We 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. Results NHS 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. Conclusions Unless 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.
Issue Date: 16-Oct-2020
Date of Acceptance: 11-Sep-2020
URI: http://hdl.handle.net/10044/1/82440
DOI: 10.1186/s12916-020-01781-w
ISSN: 1741-7015
Publisher: BioMed Central
Start Page: 1
End Page: 12
Journal / Book Title: BMC Medicine
Volume: 18
Issue: 329
Copyright Statement: © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Sponsor/Funder: Medical Research Council (MRC)
National Institute for Health Research
Abdul Latif Jameel Foundation
Funder's Grant Number: MR/R015600/1
NIHR200908
Keywords: COVID-19
Critical care
Elective surgery
General & acute
Hospital capacity
Interventions
General & Internal Medicine
11 Medical and Health Sciences
Publication Status: Published
Online Publication Date: 2020-10-16
Appears in Collections:Imperial College Business School
Department of Infectious Diseases
Faculty of Medicine
Imperial College London COVID-19
School of Public Health



This item is licensed under a Creative Commons License Creative Commons