key: cord-1042962-mdukw5xl
authors: Román, Antonio; Cossio-Gil, Yolima; Aller, Marta-Beatriz; Abadias, María-José; Cebrián, Rocío; Barba, María-Àngels; Rodríguez, Isabel; Domínguez, José-Manuel; Campins, Magdalena; Almirante, Benito; Romea, María-Soledad; Martínez, Jesús; Suárez, Montserrat; Romero, Rosa; de Aguileta, Begoña López; Cortés, Sonia; Tomás, Esther; García, Fran; Civit, Carles; Pumarola, Tomàs; Bravo, Inés; Arranz, María; González, Antonio; Genescà, Joan; Ferrer, Jaume; Ferrer, Ricard; Carbonell, Marta; Estany, Jaume; Salazar, Albert
title: Transforming a public university hospital and its area of influence into a comprehensive resource in response to the COVID-19 pandemic
date: 2022-03-10
journal: J Healthc Qual Res
DOI: 10.1016/j.jhqr.2022.02.006
sha: 9b486bcc1f76eacf1ab1d5f305248d66c6cccebc
doc_id: 1042962
cord_uid: mdukw5xl

Introduction and Objectives: The outbreak of COVID-19 has overwhelmed healthcare systems all over the world. The aim of this article is to describe the process of transforming the Vall d’Hebron University Hospital, the second largest hospital in Spain, into a COVID-19 centre coordinating response to the pandemic in its reference area. Materials and methods: The study draws on the experience of the authors in transforming the hospital into a comprehensive resource in response to the COVID-19 pandemic. The strategy is based on four central strategies: early planning, coordination of all healthcare agents in its reference area, definition of clear leadership roles, and the organisation of care based on multidisciplinary teams with minimal recruitment of new staff. Results: The transformation strategy enabled the hospital to cope with the surge in patients without exceeding its capacity. During the response phases, which amounted to a period of 57 days, 3,106 patients consulted the ER and 2,054 were admitted, 346 of whom were treated at the ICU. To accommodate the number of adult COVID-19 patients, adult ICU availability was progressive increased by 371%, and ordinary beds increased by 240. A total of 671 staff members went on sick leave after testing positive for COVID-19. Conclusion: The transformation experience of the hospital provides insight into how effectively adapt the structures and functioning of large hospitals. The relevance of territorial coordination during the pandemic is stressed as an effective strategy that contributed coping the pandemic.

Conclusion. The transformation experience of the hospital provides insight into how effectively adapt the structures and functioning of large hospitals. The relevance of territorial coordination during the pandemic is stressed as an effective strategy that contributed coping the pandemic.

Introducción y objetivos: La pandemia de COVID-19 ha sobrepasado los sistemas sanitarios de todo el mundo. El objetivo de este artículo es el de describir el proceso de transformación del Hospital Universitario Vall d'Hebron, segundo hospital más grande de España, en un centro de respuesta coordinada a la pandemia de COVID-19 en su área de referencia.

Materiales y métodos: Este estudio muestra la experiencia de los autores en la transformación del hospital en un importante recurso en respuesta a la pandemia de COVID-19. La estrategia seguida se basa en cuatro ejes centrales: planificación previa, coordinación de los agentes sanitarios en el área de referencia, definición clara de las funciones de los cargos de liderazgo, y organización de la atención basada en equipos multidisciplinarios con la mínima contratación de nuevo personal.

Resultados: La estrategia de transformación permitió al hospital hacer frente a la oleada de pacientes sin exceder su capacidad. Durante la fase de respuesta, que duró 57 días, 3.106 pacientes acudieron a urgencias y 2.054 fueron ingresados, 346 de los cuales fueron tratados en la UCI. Para atender al gran número de pacientes adultos de COVID-19, la UCI de adultos se amplió progresivamente hasta un 371%, y el número de camas normales aumentó en 240. Un total de 671 miembros del personal tuvieron la baja por enfermedad después de ser positivos en el test de COVID-19.

Conclusión: La experiencia adquirida durante esta transformación aporta una visión de cómo adaptar efectivamente la estructura y la función de grandes hospitales. La importancia de la coordinación Some previous research report the transformation processes of healthcare hospitals into COVID-19

centres. In China, where most reports have been published, the national strategy was oriented towards concentrating patients, health staff, resources and treatments in special facilities 3 including the construction of temporary ark hospitals to treat mildly ill patients 4 and the creation of makeshift hospitals in existing buildings 5 . In Italy, the hospital in Lodi, Lombardy centralised the management of the pandemic inside a crisis unit which worked in close contact relation with the regional authorities and reorganised its entire hospital infrastructure in record time 1 . In France, the Assistance Publique-Hôpitaux de Paris developed a data-driven strategy based on the coordinated management of their centres, using multidisciplinary working groups and developing a unified platform to recruit human resources and a central ICU bed-allocation system 6 .

In Spain, the first case of COVID-19 was confirmed on January 31 in La Gomera in the Canary Islands. coverage to a population of around 450,000 people. It is also a reference hospital at regional and national level for highly complex procedures and rare diseases. Each year, the hospital performs around 36,000 major surgical procedures, 420 transplants, 60,000 hospitalisations, 210,000 emergency care contacts, and over a million outpatient consultations.

Countries around the world are currently facing the threat of successive waves of the pandemic.

However, unlike the first wave, we have now the experience and several strategies put in place, such as response plans and coordination structures, which may assist hospitals in their response. Here, we describe the transformation of the HUVH, the second biggest hospital in Spain, into a COVID-19 hospital which coordinates action at territorial level with public and private hospitals inside its reference area. Our aim is to provide useful information on effective management and organizational strategies that we hope will be a valuable resource for other hospitals around the world to respond further pandemic waves.

The Executive Board (EB) of the HUVH, comprising its CEO and Directors, is the hospital's highest planning and decision-making body. In mid-January 2020, to prepare the hospital for the imminent pandemic, the EB decided: (i) to create a COVID-19 Task Force, (ii) to plan the organisational transformation of the hospital during the pandemic, and (iii) to lead the coordination among healthcare agents in the area to ensure the most efficient allocation of patients and resources. By 12 then, the spread of COVID-19 as a global pandemic was already a likely scenario and these measures were designed to avoid risks related to improvisation, tension, the lack of coordination between different actors, and deficiencies of essential resources. (iii) Territorial coordination was one of the most important activities for guaranteeing the availability of resources. The aim was to map and coordinate all the available resources in the area that could be fully dedicated to attending to COVID-19 patients, including public and private health care centres (hospitals, primary care, social care, clinics) and non-health centres such as sports centres and hotels.

To prepare this unprecedented move, the EB made an agreement with the five hospitals in the territory to simultaneously transform these hospitals into a coordinated network of COVID-19 hospitals. The participating hospitals were Hospital San Rafael, Hospital Pere Virgili, Hospital Isabel Roig, Hospital Quirón and Hospital HM Delfos. This agreement was approved by the regional healthcare authority.

The response to the first wave of the pandemic can be divided into four phases (see figure 1 ). The specific actions implemented are described below.

The preparation phase began once the risk of a pandemic became real. The first step was the creation of the COVID-19 Task Force. The first case in Spain was reported on January 31 2020; during this phase, actions were mainly focused on defining the basis for coordinated action, including the analysis of possible scenarios and actions to deal with risks, the definition of specific workflows, and the establishment of communication channels with staff. When hypothetical scenarios were analysed, only the ones in which a successful response of the hospital was possible were considered: catastrophic scenarios that might have had a paralysing effect were avoided.

Infection prevention and control measures. The EB and the COVID-19 Task Force defined the necessary premises for guaranteeing the safest possible conditions for healthcare professionals. As early as the second week of February, a specific workflow in the emergency rooms (ER) for COVID-19-suspected patients was defined. In contrast to the protocols in place and to avoid the risk of misdiagnosis, we assumed that communitarian virus transmission might be possible from the very beginning. Consequently, all patients with suspected pneumonia or respiratory infection who were admitted to the emergency room were placed in specific ER boxes and tested for SARS-CoV-2 by PCR.

The hospital's microbiology laboratory was in charge of conducting PCR tests, although at that moment the recommendation was that a centralised laboratory should carry out tests for the whole of Catalonia. Experienced infectious disease specialists joined ER staff in attending to the COVID-19 suspected patients.

Real time data analysis and information systems. Epidemiologists modelled possible scenarios according to the epidemiological data available. These scenarios, updated as new data emerged, number of available beds were carried out. All scheduled non-urgent surgery was cancelled on March 16, including transplants, thus making more beds available to treat COVID-19 patients. The cancellation of the transplant programme, one of the hospital's most emblematic activities, was seen by the staff as an unequivocal message regarding the seriousness of the situation. Many areas of the hospital were converted to create additional inpatient and ICU wards, including outpatient clinics and administrative areas. In addition, 132 beds were added for the treatment of patients who were not candidates for ICU admission by expanding the hospital facilities to the Olympic Sports pavilion, located across the road from the hospital. Finally, two nearby hotels were adapted to be able to admit discharged patients and staff who lacked adequate isolation conditions in their homes. The hospital was in charge of providing the resources, logistics and care required in these hotels. The recovery phase started when there was evidence of the remission of the epidemic, with a decrease in the number of admissions below ten patients per day, and a sustained increase in the number of daily discharges. This phase aimed to be a transition towards normality in the hospital. At this point, the transformation strategy focused on structuring the coexistence of COVID-19 and non-COVID-19 activity. The main activities were the reorganisation of the ER and the hospitalisation and short time; in contrast, the pandemic situation starts insidiously, may affect the entire world, and can range in length from several weeks to months. Thus, the strategy applied should optimise the use and distribution of the hospital's material and human resources.

The HUVH's approach to guarantee the availability of sufficient resources has been innovative, although some of the strategies deployed have also been reported in other countries in the context of the COVID-19 pandemic 1, 6, 12 . In this regard, territorial coordination is of paramount importance.

Instead of rapidly creating temporary hospitals in the territory, as was the case in China 4 , our hospital led a coordinated action aimed at making an efficient use of the health and non-health resources already available. A network of public and private facilities and organisations worked together to ensure that patients were attended to in the best place possible according to their specific care needs. Coordination was possible due to the willingness of the various actors for collaborating, and to the firm leadership of the hospital, which from the beginning transmitted the message that the epidemic could only be faced through the joint commitment of all the stakeholders.

The experience of this coordination has created a unique opportunity to improve care integration in the area, establish operational flow circuits of patients, improve the data information flow to the professionals, and define the basis for further collaboration for the benefit of patients.

The successful transformation of the HUVH was also possible due to the design of visible and coordinated leadership roles from the start of the pandemic threat. Leadership is recognised as the cornerstone of crisis management 13 , and strong management and clinical and scientific leadership roles served to provide consistency, agility and adaptability in the transformation of the hospital as the pandemic unfolded, as observed in other contexts 14 . Input from the scientific leaders allowed the management leaders to plan actions and make informed decisions, which were then applied by the clinical leaders in the daily activities of the hospital. The clear definition of the leadership roles and regular communication made possible the prompt deployment of the pandemic response plan., . This

COVID-19 Epidemic in the Middle Province of Northern Italy: Impact, Logistics, and Strategy in the First Line Hospital

COVID-19 pandemic: perspectives on an unfolding crisis

Report of the WHO-China joint mission on coronavirus disease 2019 (COVID-19)

The application of Temporary Ark Hospitals in controlling COVID-19 spread: the experiences of one Temporary Ark Hospital

The hospital response to covid-19 in China

Assistance Publique-Hôpitaux de Paris' response to the COVID-19 pandemic

Emergency reconstruction of large general hospital under the perspective of new COVID-19 prevention and control

Critical care crisis and some recommendations during the COVID-19 epidemic in China

Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study

Hospital preparedness for COVID-19 pandemic: experience from department of medicine at Veterans Affairs Connecticut Healthcare System

Leader cognition in real-world settings: How do leaders think about crises? Leadersh Q

Healthcare Leadership in the COVID-19 Pandemic: From Innovative Preparation to Evolutionary Transformation