Adapting hospital capacity to meet changing demands during the COVID-19 pandemic.
Adapting hospital capacity to meet changing demands during the COVID-19 pandemic.
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DOI：
10.1186/s12916-020-01781-w
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发表时间：
2020-10-16
期刊：
影响因子：
9.3
通讯作者：
Hauck K
中科院分区：
文献类型：
--
作者：
McCabe R;Schmit N;Christen P;D'Aeth JC;Løchen A;Rizmie D;Nayagam S;Miraldo M;Aylin P;Bottle A;Perez-Guzman PN;Ghani AC;Ferguson NM;White PJ;Hauck K
计算通过为2019年冠状病毒病(新冠肺炎)和其他患者的紧急治疗实施的医院拨备干预措施实现的医院激增能力；评估在不同新冠肺炎患者入院水平下允许患者进行择期手术的条件。我们分析了英国国家医疗服务体系(NHS)的数据集和文献综述，以估计大流行前的医院护理能力(大流行前的基线)，并量化干预措施(取消择期手术、野战医院、使用私立医院、部署前医务人员和部署新获得资格的医务人员)对成年新冠肺炎患者的影响，重点关注普通和急诊(G&A)和重症监护(CC)床位、工作人员和呼吸机。如果没有医院提供的干预措施，英国国民健康保险制度不会有足够的能力在2020年3月和4月治疗所有新冠肺炎和其他患者，这缓解了CC护士、CC和G&A床位以及CC初级医生的严重短缺。在其他干预措施持续的情况下，所有择期手术都可以在大流行前的正常水平进行，但前提是整个英格兰每天占用CC床位的新冠肺炎患者不超过1,550人。如果不维持其他干预措施，则只有占用CC床位的新冠肺炎患者不超过320人，才能进行择期手术。然而，有更大的国家能力来治疗G&A患者：如果没有干预，需要近10,000名G&A新冠肺炎患者才能容纳任何G&A选择性患者。除非新冠肺炎住院率降至较低水平，否则英格兰仍有必要通过野战医院、使用私立医院或部署以前和新获得资格的医务人员来增强重症监护能力，以允许进行部分或全部择期手术。
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. 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. 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. 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.
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