The J-IDEA pandemic planner: a framework for implementing hospital provision interventions during the COVID-19 pandemic

Abstract

Background : Planning for extreme surges in demand for hospital care of patients requiring urgent life-saving treatment for COVID-19, whilst retaining capacity for other emergency conditions, is one of the most challenging tasks faced by healthcare providers and policymakers during the pandemic. Health systems must be wellprepared to cope with large and sudden changes in demand by implementing interventions to ensure adequate access to care. We developed the first planning tool for the COVID-19 pandemic to account for how hospital provision interventions (such as cancelling elective surgery, setting up field hospitals, or hiring retired staff) will affect the capacity of hospitals to provide life-saving care. Methods : We conducted a review of interventions implemented or considered in 12 European countries in March-April 2020, an evaluation of their impact on capacity, and a review of key parameters in the care of COVID-19 patients. This information was used to develop a planner capable of estimating the impact of specific interventions on doctors, nurses, beds and respiratory support equipment. We applied this to a scenario-based case study of one intervention, the set-up of field hospitals in England, under varying levels of COVID-19 patients. Results : The J-IDEA pandemic planner is a hospital planning tool that allows hospital administrators, policymakers and other decision-makers to calculate the amount of capacity in terms of beds, staff and crucial medical equipment obtained by implementing the interventions. Flexible assumptions on baseline capacity, the number of hospitalisations, staff-to-beds ratios, and staff absences due to COVID-19 make the planner adaptable to multiple settings. The results of the case study show that while field hospitals alleviate the burden on the number of beds available, this intervention is futile unless the deficit of critical care nurses is addressed first. Discussion : The tool supports decision-makers in delivering a fast and effective response to the pandemic. The unique contribution of the planner is that it allows users to compare the impact of interventions that change some or all inputs.