FACILITY UPGRADES
management during the surge phase of the epidemic in Japan.
Materials and methods We sent a questionnaire about the influence of the COVID-19 surge on medical services to the directors of 4,825 hospitals with over 100 beds nationwide. We asked about the type of interventions to enable admission of COVID-19 patients. We asked whether general wards had been remodelled into infection wards. We also asked healthcare staff whether they were aware of any difficulties in the provision of inpatient medical services including surgery. We excluded outpatient services, diagnostic procedures, and prescription of drugs from the analysis in the present study. We defined actual number of hospitalisations as the available bed capacity for COVID-19 patients. The bed capacity may be influenced by the nursing workforce in the ward. During the pandemic, any nurse could be asked to work in infection wards in the hospital. In order to evaluate the relative nursing workforce, patient to nurse ratio (total number of hospitalisations divided by total number of nurses) was calculated. Infection clusters can be a factor
reducing bed capacity. Therefore, we asked about the frequency of infection clusters during the study period. We classified the early phase of the
surge as the period from April (November) 2019 to March 2020 and the late phase of the surge as the period from April 2020 to March 2021. In this study, we analysed the data mainly during the late phase of the surge. All analyses were undertaken on Excel
2019, using TTEST function. CHISC.TEST function was used for statistical comparison of proportions. A p-value less than 0.05 was considered statistically significant.
Results We received 257 responses (5.3 per cent), which revealed a large increase in hospitalised COVID-19 patients throughout the pandemic surge. Out of 257 hospitals, 45 hospitals converted general wards to isolation wards for COVID-19 patients. The wards were constructed with a mixture of negative-pressure beds and normal- pressure beds. The isolated wards and patient traffic were strictly separated, adhering to a zone rule for infection. In addition, remodelling of hospital facilities included installation of simple negative- pressure units equipped with a HEPA filter, introduction of camera monitors, construction of corridor doors, and carbon dioxide detectors. The bed capacity changed over time. Major changes to the ward and staff assignment were made as a response to the pandemic. Therefore, remodelling in the
34
NS
100000 80000 60000 40000 20000 0
400 300 200 100 0
102411 80083
Total hospitalisations 88814
NS 77939
n Remodelled n Non-remodelled
COVID-19 hospitalisations 336
p<0.05
n Remodelled n Non-remodelled
p<0.05 14 Early phase 4 Late phase Figure 1. Influences of remodelling on COVID-19 hospitalisations.
present study included staff management closely related to conversion of the wards.
1) Remodelling and bed capacity for COVID-19 patients There was no significant difference in total hospitalisations between remodelled and non-remodelled hospitals throughout the pandemic. However, significantly more COVID-19 patients were admitted to remodelled hospitals than to non- remodeled hospitals in the early and late phase (p<0.05) (Fig 1). As more COVID-19 patients were admitted to the remodelled hospitals, the proportion of COVID-19 patients to total hospitalisations was significantly higher in remodelled hospitals than in non-remodelled hospitals (0.38 per cent vs. 0.11 per cent, p<0.01). Regarding the COVID-19 patients’
status, more patients on ventilators were admitted to remodelled hospitals than to non-remodeled hospitals (mean 7.9 vs. 3.1, p<0.05). On the other hand, the number of patients on ECMOs was not significantly different between remodelled and non-remodelled hospitals (mean 1.9 vs. 0.4, p=0.27). The characteristics of the patient groups were estimated by the proportion of patients on ventilators and on ECMO to the total number of COVID-19 patients. The proportion of patients on ventilators was significantly lower in remodelled hospitals than in non- remodelled hospitals (2.3 per cent vs. 3.5 per cent, p<0.01). On the other hand, the proportion of patients on ECMO did not differ significantly between remodelled
NS
500 450 400 350 300 250 200 150 100 50 0
461
and non-remodelled hospitals (0.6 per cent vs. 0.5 per cent, p=0.84).
2) Workload of COVID-19 hospitalisation In the non-remodelled hospitals, the COVID-19 hospitalisations were associated with experiencing difficulties in a comparison between hospitals where the staff experienced no difficulties and those where they experienced difficulties (51 vs. 182, p<0.01). On the contrary, no significant association was detected in remodelled hospitals (150 vs. 461, p=0.125). (Fig 2).
3) Remodelling and infection clusters In the late phase of the surge, the mean annual incidence of infection clusters was 0.22 and 0.12 in remodelled and non-remodelled hospitals, respectively. These frequencies were not significantly different (p=0.21).
4) Reasons for difficulties in provision of medical services A total of 102 responded to the descriptive questionnaire about the reasons for limiting the provision of medical services. The reasons consisted of infection control (33; 32 per cent), bed shortage (32; 31 per cent), staff shortage (24; 24 per cent), administrative requests (11; 11 per cent) and resource shortage (2; 2 per cent).
5) Remodelling and relative workforce for COVID-19 hospitalisation The COVID-19 patient: nurse ratio was significantly higher in remodelled
n Difficulties (–) n Difficulties (+)
89
p<0.01 182 150 51 Remodelled Figure 2. Workload of COVID-19 hospitalisations. IFHE DIGEST 2024 Non-remodelled
Number of COVID hospitalisations
Number of hospitalisations
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