Pandemic Responsiveness in an Acute Care Setting: A Community Hospital's Utilization of Operational Resources During COVID-19

Abstract

Background: To ensure continuity of services while mitigating patient surge and nosocomial infections during the coronavirus disease 2019 (COVID-19) pandemic, acute care hospitals have been required to make significant operational adjustments. Here, we identify and discuss key administrative priorities and strategies utilized by a large community hospital located in Ontario, Canada.

Methods: Guided by a qualitative descriptive approach, we performed a thematic analysis of all COVID-19-related documentation discussed by the hospital's emergency operation centre (EOC) during the pandemic's first wave. We then solicited operational strategies from a multidisciplinary group of hospital leaders to construct a narrative for each theme.

Results: Seven recurrent themes critical to the hospital's pandemic response emerged: 1) Organizational structure: a modified EOC structure was adopted to increase departmental interoperability and situational awareness; 2) Capacity planning: Design Thinking guided rapid infrastructure decisions to meet surge requirements; 3) Occupational health and workplace safety: a multidisciplinary team provided respirator fit-testing, critical absence adjudication, and wellness needs; 4) Human resources/workforce planning: new workforce planning, recruitment, and redeployment strategies addressed staffing shortages; 5) Personal protective equipment (PPE): PPE conservation required proactive sourcing from traditional and non-traditional suppliers; 6) Community response: local partnerships were activated to divert patients through a non-referral-based assessment and treatment centre, support long-term care and retirement homes, and establish a 70-bed field hospital; and 7) Corporate communication: a robust communication strategy provided timely and transparent access to rapidly evolving information.

Conclusion: A community hospital's operational preparedness for COVID-19 was supported by inter-operability, leveraging internal and external expertise and partnerships, creative problem solving, and developing novel tools to support occupational health and community initiatives.

Keywords: COVID-19; acute care; hospital; infection; operational; pandemic.

Figure 1

A review of all COVID-19-related documentation discussed at RVH’s EOC committee between March-June, 2020, as well as COVID-19 documentation provided by external partners between February-June, 2020, identified recurrent themes critical to RVH’s pandemic response.

Figure 2

RVH’s modified EOC structure is based on a traditional IMS system, comprised of interconnected command staff (green) and general staff (blue), with clinical operations divided into clinical care, clinical support, and capacity planning. Non-traditional sections were added to fulfil local pandemic needs, including corporate communications and resource leads.

Figure 3

A robust capacity plan guided by the principles of design thinking permitted RVH to expand its level 3 critical care capacity from 16 beds to 105 beds in 5–12 weeks, along with an additional 334 standard beds and 300 cots (not shown), as required.

Figure 4

A structured, five-step workforce planning cycle was established to identify and fulfil clinical staffing requirements, as well as cleaning staff, environmental services aides, and other staff essential to meeting workforce demands and upholding patient safety. This framework was further supported by strategies and actions to source, recruit, onboard, train, and develop staff.

Figure 5

The pandemic response unit (PRU) is a 70-bed, 8250 square-foot, four season, fully-functioning modular field hospital located in RVH’s parking lot and connected to the health centre by an enclosed walkway. The PRU is professionally staffed and fully equipped regional asset to assist RVH and partner hospitals facing capacity challenges during the COVID-19 pandemic. Of note, the PRU is not a unit for COVID patients, but for medically stable inpatients with an estimated stay of 3–5 days.