Setting up hospital care provision to patients with COVID-19: lessons learnt at a 2400-bed academic tertiary center in São Paulo, Brazil

Perondi, Beatriz; Miethke-Morais, Anna; Montal, Amanda C.; Harima, Leila; Segurado, Aluisio C.; ,

doi:10.1016/j.bjid.2020.09.005

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Brazilian Journal of Infectious Diseases

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Brief Communications • Braz J Infect Dis 24 (6) • Nov-Dec 2020 • https://doi.org/10.1016/j.bjid.2020.09.005 copy

Setting up hospital care provision to patients with COVID-19: lessons learnt at a 2400-bed academic tertiary center in São Paulo, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

As of August 30, 2020, Brazil ranked second among countries with the highest number of COVID-19 cases, with the city of São Paulo as the national epidemic epicenter. Local public healthcare institutions were challenged to respond to a fast-growing hospital demand, reengineering care provision to optimize clinical outcomes and minimize intra-hospital coronavirus infection. In this paper we describe how the largest public hospital complex in Latin America faced this unprecedented burden, managing severe COVID-19 cases while sustaining specialized care to patients with other conditions. In our strategic plan a 900-bed hospital was exclusively designated for COVID-19 care and continuity of care to those not infected with coronavirus ensured in other inpatient facilities. After 152 days, 4241 patients with severe COVID-19 were hospitalized, 70% of whom have already been discharged, whereas the remaining Institutes of the complex successfully maintained high complexity inpatient and urgent/emergency care to non-COVID-19 patients.

Keywords
Hospital care services; Inpatients; COVID-19; Brazil

Implementation phase	Aims	Actions	Timeframe
Preparedness	To establish an emergency continuity plan	Development of the EOP	Ongoing since January 2020
	To adapt the hospital structure for critical patients	Building the necessary capabilities needed to implement such plans	Ongoing since January 2020
	To recruit and train HCW in the novel care provision model	Hiring HCW and providing comprehensive training	Ongoing since March 2020
	To assess availability of necessary staff, equipment, and supplies	Predicting increase in the number of beds for ICU patients	Ongoing since February 2020
	To explore alternative sources of personnel, and critical equipment and supplies	Building partnerships and fund-raising initiatives	Ongoing since February 2020
	To develop monitoring and evaluation tools	Tracking emergency operation costs
Response	To implement the action plan	Running full emergency operation in parallel to routine hospital care	Ongoing since March 2020
Response	To maintain non-COVID-19 emergency care		Ongoing since March 2020
Recovery	To develop a progressive demobilization plan	Establishing measures to restore the hospital to its previous state	Ongoing since mid-August 2020
	To restore the affected area to its previous state - "build back better"	Establishing a transition governance board
		Recognition of staff performance and commitment
	To evaluate results of the emergency operation	Assessment of clinical outcomes during the emergency crisis
Mitigation	To reduce impact and risks of COVID-19 on the hospital	Assessing development of the EOP	Ongoing since February 2020
	To mitigate unneeded disruption of services	Decision to have a designated hospital for COVID-19 patient care
	To strengthen capacity to maintain regular operation	Transfer of regular services to other hospital institutes
	To sustain action that reduces or eliminates long-term risk to patients, HCW and hospital	Development of a long term and continuous plan	Ongoing since March 2020

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[1] *Corresponding author. E-mail address: segurado@usp.br (A.C. Segurado).