key: cord-301061-bekyn1k2
authors: Meschi, Tiziana; Rossi, Sandra; Volpi, Annalisa; Ferrari, Carlo; Sverzellati, Nicola; Brianti, Ettore; Fabi, Massimo; Nouvenne, Antonio; Ticinesi, Andrea
title: Reorganization of a large academic hospital to face COVID‐19 outbreak: The model of Parma, Emilia‐Romagna region, Italy
date: 2020-05-20
journal: Eur J Clin Invest
DOI: 10.1111/eci.13250
sha: 
doc_id: 301061
cord_uid: bekyn1k2

COVID-19 outbreak is challenging for hospital care. Development of lean, adaptable algorithms for managing patient flows may be pivotal for handling and adapting to a situation of uncertainty and evolving crisis. Here, we present the model of care adopted at Parma University-Hospital, a large teaching hospital facility located in Northern Italy, to face a massive overflow of COVID-19 patients presenting to the Emergency Department.

patients are admitted to a temporary ward, where laboratory tests for SARS-CoV-2 are performed. If positive, patients are transferred either to infectious disease unit or to internal medicine ward clusters exclusively dedicated to COVID-19 management.

The involved radiology service and the medical wards initially involved in the path are located in the same building. The COVID-19-dedicated ward clusters have been activated gradually by progressive reconversion of general medical, geriatric, rehabilitation wards and outpatient areas (total capacity 260 beds). Reconversion of other medical wards of the hospital, located in other buildings, with activation of a dedicated mobile CT, has then been performed with increasing patient flows (final capacity >600 beds).

ICU transferal is possible at every step. COVID-19dedicated ICU clusters have been progressively activated by reconversion of post-surgical and specialist ICU services (60 beds).

This model shares some common features, including pre-triaging and reconversion of wards, with models implemented in other hospitals of Northern Italy. 5 However, the inclusion of chest CT at an early stage of patient management and clusterization of medical and ICU beds represent the main points of strength and novelty of the present model, ameliorating clinical management of patients and facilitating hospital organization in a moment of evolving crisis.

COVID-19 outbreak is challenging for hospital care. Development of lean, adaptable and multidisciplinary algorithms for managing patient flows may be pivotal for the local governance of COVID-19 pandemic.

All the authors report no competing interests.

Dr Ticinesi had full access to all of the data in the study and takes the responsibility for the integrity of data. Concept and design: Meschi, Rossi, Volpi, Brianti, Fabi. Drafting of the manuscript and literature review: Ticinesi. Critical revision of the manuscript for important intellectual content: Nouvenne.

Tiziana Meschi 1, 2 Sandra Rossi 3 Annalisa Volpi 3 F I G U R E 1 Algorithm of management and flows of suspect COVID-19 cases adopted in Parma University Hospital. The whole algorithm is superintended by a hospital COVID-19 crisis unit. Patient flows are managed by a clinician in charge of the crisis unit, with strong expertise in hospital organization and bed managing. COVID-19-dedicated wards have been obtained by reconversion of internal medicine, geriatric and rehabilitation wards, whose patients have been transferred to community hospitals or territorial facilities. The involved radiology service is dedicated exclusively to COVID-19 diagnostics and available 24/7 for the needs of ED, ICU, Infectious Disease or COVID-19dedicated wards. COVID-19 wards are jointly managed by internal medicine, emergency medicine, geriatrics, intensive care and infectious disease specialists. ED, Emergency Department; HRCT, High-Resolution Computed Tomography; RR, Respiratory Rate

Italian Ministry of Health Covid-19 Bulletin

Covid-19: decentralisation, and the hunt for patient zero

Clinical characteristics of coronavirus disease 2019 in China

The response of Milan's Emergency Medical System to the COVID-19 outbreak in Italy

Fast reshaping of intensive care unit facilities in a large metropolitan

Licence and can be freely available at the following links: https://smart.servi er.com/ and https://pixab ay.com.

Tiziana Meschi and Sandra Rossi share first authorship.

https://orcid.org/0000-0001-9171-8592