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. 2022 Oct;37(5):600-608.
doi: 10.1017/S1049023X22001169. Epub 2022 Aug 11.

Managing Hospital Capacity: Achievements and Lessons from the COVID-19 Pandemic

Enrico R de Koning  1 , Mark J Boogers  2 , Saskia Lma Beeres  2 , Iwona D Kramer  3 , Wouter J Dannenberg  3 , Martin J Schalij  1   2   4
Affiliations

Managing Hospital Capacity: Achievements and Lessons from the COVID-19 Pandemic

Enrico R de Koning et al. Prehosp Disaster Med. 2022 Oct.

Abstract

Introduction: The coronavirus disease 2019 (COVID-19) pandemic challenged health care systems in an unprecedented way. Due to the enormous amount of hospital ward and intensive care unit (ICU) admissions, regular care came to a standstill, thereby overcrowding ICUs and endangering (regular and COVID-19-related) critical care. Acute care coordination centers were set up to safely manage the influx of COVID-19 patients. Furthermore, treatments requiring ICU surveillance were postponed leading to increased waiting lists.

Hypothesis: A coordination center organizing patient transfers and admissions could reduce overcrowding and optimize in-hospital capacity.

Methods: The acute lack of hospital capacity urged the region West-Netherlands to form a new regional system for patient triage and transfer: the Regional Capacity and Patient Transfer Service (RCPS). By combining hospital capacity data and a new method of triage and transfer, the RCPS was able to effectively select patients for transfer to other hospitals within the region or, in close collaboration with the National Capacity and Patient Transfer Service (LCPS), transfer patients to hospitals in other regions within the Netherlands.

Results: From March 2020 through December 2021 (22 months), the RCPS West-Netherlands was requested to transfer 2,434 COVID-19 patients. After adequate triage, 1,720 patients with a mean age of 62 (SD = 13) years were transferred with the help of the RCPS West-Netherlands. This concerned 1,166 ward patients (68%) and 554 ICU patients (32%). Overcrowded hospitals were relieved by transferring these patients to hospitals with higher capacity.

Conclusion: The health care system in the region West-Netherlands benefitted from the RCPS for both ward and ICU occupation. Due to the coordination by the RCPS, regional ICU occupation never exceeded the maximal ICU capacity, and therefore patients in need for acute direct care could always be admitted at the ICU. The presented method can be useful in reducing the waiting lists caused by the delayed care and for coordination and transfer of patients with new variants or other infectious diseases in the future.

Keywords: COVID-19; capacity; coordination; transfer; triage.

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Figures

Figure 1.
Figure 1.
Overview of Available Beds (green) and Occupied Beds (light blue) for Nursing Ward (left panel) and ICU (right panel) for COVID-19. Note: The black line displays the regional “fair share.” Abbreviations: COVID-19, coronavirus disease 2019; ICU, intensive care unit.
Figure 2.
Figure 2.
System for Triage of COVID-19 Patients. Note: The overcrowded hospital (red) contacts the RCPS West-Netherlands triage hotline for a PMR. If transfer is safe, the RCPS West-Netherlands selects the best suited hospital for transfer and transfers to one of the available hospitals (orange, blue, green). Abbreviations: COVID-19, coronavirus disease 2019; RCPS, Regional Capacity and Patient Transfer Service; PMR, patient movement request; MICU, Mobile Intensive Care Unit.
Figure 3.
Figure 3.
Number of Transfers by RCPS West-Netherlands for ICU (red) and Nursing Ward (green) per Month from March 2020 - November 2021. Abbreviations: RCPS, Regional Capacity and Patient Transfer Service; ICU, intensive care unit.
Figure 4a.
Figure 4a.
Nursing Ward Occupancy for COVID-19 (blue) in West-Netherlands and the Potential Occupancy if there had been No Patient Transfers (orange). Abbreviation: COVID-19, coronavirus disease 2019.
Figure 4b.
Figure 4b.
ICU Occupancy for COVID-19 (blue) in West-Netherlands and the Potential Occupancy (orange). Note: The red line corresponds with the regular ICU capacity for all patients. Abbreviations: COVID-19, coronavirus disease 2019; ICU, intensive care unit.
Figure 5a.
Figure 5a.
True ICU Occupancy of COVID-19 Patients of a Single Hospital in a Highly Urban Area (blue) and Potential ICU Occupancy if Patients hadn’t been Transferred (orange). Abbreviations: COVID-19, coronavirus disease 2019; ICU, intensive care unit.
Figure 5b.
Figure 5b.
Total ICU Occupancy of a Tertiary Care Hospital Consisting of Patients Directly Admitted to the Hospital (dark blue) and Patients Transferred to the Hospital (light blue). Abbreviation: ICU, intensive care unit.
Figure 6.
Figure 6.
National ICU Occupancy Relative to “Fair Share” for the Second Wave Starting in September 2020. Note: West-Netherlands in blue, all other regions in the Netherlands in grey. Abbreviation: ICU, intensive care unit.
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