FACILITY UPGRADES
Table 1. Remodelling of hospital facilities and outcomes. Strategy
1 Architectural, engineering, and construction changes l Conversion of general wards to isolation wards
Outcome l Expansion of bed capacity
l Installation of simple negative-pressure units equipped with HEPA filter l Improvement of relative workforce efficiency l Construction of corridor doors l Introduction of camera monitors l Carbon dioxide detectors
2 Staff and patient management l Reassignment of personnel
l Separating contagious patient traffics l Screening patients before entering wards
hospitals than in non-remodeled hospitals in the late phase of the surge (1.69 vs. 0.38, p<0.05). However, in the subgroup analysis stratified by patients’ status, i.e., those on ventilators and on ECMO, the difference between remodelled and nonremodelled hospitals did not reach statistical significance (0.014 vs. 0.007 on ventilators, p=0.12; 0.002 vs. 0.001 on ECMO, p=0.23). In the non-remodeled hospitals, the
COVID-19 patient: nurse ratio was significantly higher in hospitals where the staff experienced difficulties than in those where the staff did not experience any difficulties (p<0.05). This also appeared to be the case regardless of patients’ status in the non-remodeled hospitals (0.014 vs. 0.004 on ventilators, p<0.05; 0 vs. 0.001 on ECMO, p<0.05). In contrast, in the remodelled hospitals, there were no significant differences in these ratios between hospitals with and without difficulties (Fig 3).
6) Incidence of clusters In the remodelled hospitals, the annual incidence of clusters in the late phase of the surge was significantly higher in hospitals with difficulties than in those without difficulties in provision of medical services (0.37 vs. 0, p<0.01) (Fig 4).
Discussion
Our data demonstrated that the remodelling of hospital facilities was associated with expansion of bed capacity for COVID-19 patients without a significant increase in infection clusters. It was also demonstrated that a large number of the admitted COVID-19 patients were on ventilators; nevertheless, this proportion was kept low in comparison with that in non-remodeled hospitals. This indicates that remodelling enabled hospitals to accommodate more COVID-19 patients
2.50 2.00 1.50 1.00 0.66 0.50 0.26 0 Remodelled Figure 3. Staff strain and COVID-19 hospitalisations.
without ventilators or ECMO. Our study also revealed that the COVID-19 patients: nurse ratio was significantly higher in remodelled hospitals than in those without remodelling. Remodelling appeared to improve the efficiency of nursing practice for COVID-19. These changes did not depend on the patients’ status because there were no significant differences in the patients: nurse ratio, regardless of the medical equipment COVID-19 patients were on. Because of the quality of the HVAC systems of many converted wards, the makeshift hospital wards are possibly more useful for providing medical care for patients with mild to moderate symptoms. Some previous reports have pointed out the importance of architectural and engineering modifications other than management of staff and patients.4 However, the concept of remodelling is different from simple modification of the hospital infrastructure, such as repurposing other non-ICU beds to ICU beds and setting up de novo ICUs or field hospitals. Remodelling is even different from long- term architectural and engineering strategies such as construction of hospital buildings with flexible bed capacity for
The COVID-19 patients: nurse ratio was significantly higher in remodelled hospitals than in those without remodelling
IFHE DIGEST 2024
medical space. We attempted to increase bed capacity by running existing beds more efficiently by infrastructure adaptation together with management of human resources. This paper presents the outcomes of this strategy. In the present study, we examined the
subjective views of healthcare staff. In the remodelled hospitals, neither the increased patients: nurse ratios nor COVID-19 hospitalisations was associated with experiencing difficulties. It is suggested that workload may be reduced not only by physically increased bed capacity or improved efficiency of medical practices. The responses to the descriptive questionnaire revealed that there were three main reasons for difficulties with COVID-19 hospitalization; i.e., infection control, bed shortage and staff shortage. Our results also suggested that the hospital facilities could solve staff and bed shortages, but remodelling could not necessarily solve the staff’s strain or workload caused by infection clusters. In remodelled hospitals, the incidence of clusters was associated with the staff’s experience of difficulties despite that the frequency of clusters was not associated with increased COVID-19 hospitalisations. The strategies for remodelling mainly deal with hospital infrastructure; nevertheless, other concurrent and complementary activities were also required in the COVID-19 crisis management response such as
35 Non-remodelled 1.98 1.49 p<0.05 NS
l Recruitment of staff, but no relief of stress related to infection
n Difficulties (–) n Difficulties (+)
COVID patient : nurse ratio
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