How are university hospitals coping with the COVID-19 pandemic in Brazil?

Documentary study based on information available on official websites of 44 university hospitals in the federal teaching network in Brazil. The survey was conducted in April and May 2020. The excerpts were grouped by similarity, considering the Care, Management, Extension, Teaching and Research dimensions. Descriptive statistics was used for data analysis.

Results

The 495 actions identified to cope with the COVID-19 pandemic were distributed among Care (38.99%), Management (37.58%), Extension (16.16%) and Teaching and Research (7.27%). In Care, the highlights were the suspension of consultations not related to COVID-19 and elective surgeries, and changes in routines with focus on biosafety issues to prevent virus transmission. In Management, new professionals were hired and health teams were trained. In the Extension dimension, educational materials were developed, mainly on COVID-19 prevention measures. In relation to Teaching and Research, educational-training activities were suspended and the engagement of hospitals in the development of research on the subject stood out.

Conclusion

University hospitals are reorganizing care and looking for ways to provide the necessary conditions to fulfill their mission within the National Health System context, based on care, management, extension, teaching and research actions.

Coronavirus; Coronavirus infections; Pandemics; COVID-19; Health management; Hospitals, university

Regions	Exclusive service by SUS*		Classification of hospital*		Number of professionals*				Number of general beds*				Number of ICU beds**
Regions	Yes	No	Specialized	General	Up to 700	701 - 1,400	1,401 - 2,100	>2,101	Up to 100	101 - 200	201 - 300	>301	Up to 10	11 -20	21 -30	>31
Midwest and DF	1(20)	4(80)	-	5(100)	-	2(40)	2(40)	1(20)	-	2(40)	2(40)	1(20)	-	3(75)	-	1(25)
Northeast	-	17(100)	4(23.5)	13(76.5)	3(17.6)	5(29.4)	6(35.3)	3(17.6)	4(23.5)	4(23.5)	7(41.2)	2(11.8)	8(50)	2(15.2)	4(25)	2(12.5)
North	1(50)	1(50)	1(50)	1(50)	1(50)	1(50)	-	-	1(50)	-	1(50)	-	1(100)	-	-	-
Southeast	2(13.3)	13(86.7)	5(33.3)	10(67.7)	5(33.3)	1(6.7)	4(26.7%)	5(33.3)	5(33.3)	2(13.3)	4(26.7)	4(26.7)	2(20)	2(20)	2(20)	4(40)
South	1(20)	4(80)	-	5(100)	-	-	2(40)	3(60)	-	-	2(40)	3(60)	2(40)	-	1(20)	2(40)

Care (n=193)	n(%)
Suspension and/or postponement of consultations or outpatient care	37(19.17)
Restriction and/or suspension of visits	35(18.13)
Suspension and/or postponement of elective surgery	29(15.03)
Restriction of circulation of companions around the hospital	24(12.44)
Definition of flowchart and care protocols for patients suspected of being infected with COVID-19	22(11.40)
Implementation of video calls between patients, family members and health staff	20(10.36)
Suspension and/or postponement of exams	16(8.29)
Issuance of prescription and appraisal reports by e-mail	3(1.55)
Motivational messages in the lunchbox of inpatients with suspected COVID-19	2(1.04)
Screening of companions and visitors to detect respiratory problems	2(1.04)
Adoption of care referrals to urgent and emergency cases	2(1.04)
Development and distribution of therapeutic kits for patients in isolation	1(0.52)
Management (n=186)	n(%)
Training of professionals to manage COVID-19	36(19.35)
Emergency hiring of health professionals	34(18.28)
Offer of psychological care to workers	22(11.83)
Campaign for the collection of PPE and financial donations for the acquisition of ventilators	14(7.53)
Development of contingency plan for tackling COVID-19	13(6.99)
Campaign to thank and encourage health professionals	8(4.30)
Opening of a specific unit for patients with COVID-19	8(4.30)
Purchase of inputs and personal protective equipment (PPE)	8(4.30)
Provision of special accommodation for health professionals	7(3.76)
Opening of new ICU beds for patients with COVID-19	7(3.76)
Conducting COVID-19 tests for healthcare professionals	7(3.76)
Vaccination campaign against influenza for health professionals	5(2.69)
Redistributing and/or putting professionals from risk groups on leave	4(2.15)
Organization of exclusive teams to assist patients with COVID-19	3(1.61)
Distribution of 70% alcohol gel tubes for professionals	3(1.61)
Creation of a flu syndrome clinic for professionals and students	2(1.08)
Holding a general meeting on COVID-19 at the institution	2(1.08)
Search for volunteer professionals	1(0.54)
Blood donation campaign	1(0.54)
Sanitation in areas of high circulation	1(0.54)

Extension (n=80)	n(%)
Development of educational materials on prevention of COVID-19	27(33.7)
Development of campaigns to receive donations from community resources	24(30.0)
Teleorientation for patients and teleconsultation for health professionals	12(15.0)
Dissemination of tips and online activities for the community in social isolation	10(12.5)
Suspension of events and interruption of extension projects	7(8.7)
Teaching and Research (n=36)	n(%)
Suspension of teaching activities (undergraduate, postgraduate) in general (theoretical, practical, internships), of new research projects (except those focused on COVID-19) and events, and adaptation of activities of residency programs	11(34.3)
Development of scientific research on epidemiological aspects, diagnosis, prevention and treatment of COVID-19	9(25.0)
Use of information and communication technologies (remotely) in teaching and exchange of information between professionals	6(16.6)
Development of technologies to support the coping with COVID-19	5(13.8)
Training actions for students and residents for coping with COVID-19	5(13.8)

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author José Luís Guedes dos Santos. E-mail: jose.santos@ufsc.br