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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 2  |  Page : 144-147

Hospital resource planning for the COVID pandemic


1 Department of Oral and Maxillofacial Surgery, B J S Dental College and Research Institute, Ludhiana, Punjab, India
2 Department of Cardiology, Air Force Central Medical Establishment, New Delhi, India
3 Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
4 Department of Pharmacology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
5 Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
6 Department of Law, AZB and Partners, New Delhi, India
7 Departments of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana, Punjab, India

Date of Submission04-May-2020
Date of Decision20-May-2020
Date of Acceptance31-May-2020
Date of Web Publication16-Jul-2020

Correspondence Address:
Dr. Bishav Mohan
Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana - 141 001, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpcs.jpcs_41_20

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  Abstract 


Introduction: Throughout the history of world, we have witnessed many epidemics and pandemics associated with considerable morbidity, mortality which has resulted in economic crisis and a massive collateral damage to humanity. In the backdrop of the policies and guidelines to handle any pandemics or epidemics, it is imperative that we strengthen the core public health infrastructure. In this article, we have made an attempt to highlight the requirement of a health care facility which should have the capacity to handle 250 patients amidst an ideal and resource limited setting of containment and mitigation. Aims and Objective: To run a health care facility for treating 250 COVID-19 positive patients categorised into 3 levels. To use manpower in an ideal and resource limited scenario. Methods and Material: The hospital is divided into 3 levels and depending upon the severity. 150 beds are given to mildly symptomatic with risk factors (diabetes, hypertension, CKD, immunocompromised, age >60, requiring oxygen therapy and monitoring). 60 beds are given to patients moderately sick {mild ARDS patients}with continue requirement of oxygen by different other modes (high flow nasal cannula, protected non-invasive ventilation, active use of prone position) not responding to usual management. 40 beds are reserve for the patient requiring ventilatory support. Conclusion: The pandemic of COVID because of its infectious nature has burdened the healthcare system as well as safety of the care givers. The economic burden of consumable is far-far less as compared to the requirement of human resources and this challenge is faced globally.

Keywords: COVID, pandemic, resources, personal protective equipment


How to cite this article:
Kaura S, Singh N, Naik N, Roy A, Kaushal S, Mahajan R, Gupta G, Wander GS, Mohan B. Hospital resource planning for the COVID pandemic. J Pract Cardiovasc Sci 2020;6:144-7

How to cite this URL:
Kaura S, Singh N, Naik N, Roy A, Kaushal S, Mahajan R, Gupta G, Wander GS, Mohan B. Hospital resource planning for the COVID pandemic. J Pract Cardiovasc Sci [serial online] 2020 [cited 2020 Sep 20];6:144-7. Available from: http://www.j-pcs.org/text.asp?2020/6/2/144/289992




  Introduction Top


A pandemic is known to have caused widespread morbidity and mortality across the masses. In the last century, we have witnessed four pandemics: (i) Spanish Flu (1918–1920), (ii) Asian Flu (1956–1958), (iii) Hong Kong Flu (1968), and (iv) HIV/AIDS crisis (2005–2012). The latest addition to this list has been the unprecedented COVID-19 pandemic. While each of these pandemics has helped the nations to prepare for any next calamity, there has been a deficiency in the level of preparedness across developed and developing countries in this current crisis. The developed countries are facing serious shortages on all fronts – from workforce to diagnostic kits, drugs, hospital beds, etc. Simultaneously, the emerging economies are struggling due to lack of basic health infrastructure and limited resources.

Over the course of time, the knowledge about management of infectious diseases has evolved and disseminated; however, the hospitals in developing countries are not well prepared to handle contagious disease outbreaks. With the advancement and the effective use of vaccinations against many contagious diseases, the requirement and the dependency to maintain the adequate protective equipment (to combat contagious disease outbreaks) in hospitals have reduced. It is important to note that having adequate personal protective equipment (PPE) reduces the chance of infection among the healthcare staff. It is worth noting that the hospitals in China were an important nosocomial source of infection for this pandemic.[1]

COVID-19 is rapidly emerging as a perfect pathogen as it has a long asymptomatic phase in which the patient remains contagious; in addition, it is effectively transmitted in droplets, aerosols, and fomites producing a mild flu-like infection in most people. Containment of this agent is the challenging task for most healthcare systems. There have been national and international guidelines to support preparedness for COVID-19. However, the data on required workforce and cost far running the COVID facility are lacking in India. In this article, we have highlighted the requirement of a hypothetical healthcare facility that can treat 250 COVID-19 patients taking into account the workforce and usage of PPEs.

Aims and objective

(1) To run a healthcare facility for treating 250 COVID-19-positive patients categorized into three levels. (2) To use workforce in an ideal and resource-limited scenario.


  Materials and Methods Top


The hospital is divided into three levels depending upon the severity. One hundred and fifty beds are given to mildly symptomatic with risk factors (diabetes, hypertension, chronic kidney disease, immunocompromised, age >60, requiring oxygen therapy, and monitoring). Sixty beds are given to the patients moderately sick (mild acute respiratory distress syndrome patients) with continued requirement of oxygen by different other modes (high-flow nasal cannula, protected noninvasive ventilation, and active use of prone position) not responding to usual management. Forty beds are reserve for ventilator patients. The beds are allotted as per the current scenario (2%–3% needs ventilation and 10% need intensive care unit [ICU] care); this facility will also cater to nearby centers lacking level 2 and level 3 care.

Workforce requirement

The doctor-to-patient ratio is based upon our survey from different hospitals with bed capacity of 250 or more treating non-COVID patients.

The workforce required to handle such a pandemic will be divided into separate teams (as discussed later) wherein each team is involved with clinical care of Level 1, 2, and 3 patients.

  • In an ideal scenario, the above-discussed three levels will have four teams each (A, B, C, and D). Then, from these four teams, one team will work for 1 week and proceed for quarantine of 2 weeks. In an unfortunate eventuality of any one team getting infected, the next team gets over and will follow the roster rotation. In this manner, reserve workforce is always available. The patient-to-caregiver ratio is in Tables
  • However, in a compromised scenario wherein minimum healthcare workers are available, we will formulate only three teams (A, B, and C) and caregiver-to-bed ratio is doubled. Each team will work for 1 week and proceed for quarantine of 2 weeks. If any one team is infected, the next team gets over and will follow the roaster rotation. In this scenario, we have given 10% of the total requirement as standby
  • Three senior administrative doctors will coordinate the whole operation
  • One each consultant from both anesthesiology and medicine is mandatory for each rotation in each team on level 2 and 3 group of patients.


Healthcare professional requirements

  • Level 1 care (150 mildly symptomatic patients with high-risk factors requiring admissions)


  • [Table 1]a shows the ideal scenario for workforce required to manage level 1 patients requiring 150 beds. For level 1 patients, consultant will be on-duty for 12 h in the morning and will be on-call at night. The calculated workforce for consultants particularly if they are on-call at night can be modified depending on the availability of the resources; the remaining staff will be there for 6 h shift.


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    [Table 1]b shows the minimum requirement for workforce required to manage level 1 patients requiring 150 beds. For level 1 patients, consultant will be on-duty for 12 h and on-call duty at night; the remaining staff will be there for 6-h shift. Here, the caregiver and bed ratio is doubled.

  • Level 2 and 3 care


To manage level 2 (ICU care) and level 3 (ventilator support) patients, we have decreased the caregiver and bed ratio accordingly. Six-hour shift of medical officers and other staff is the same. However, the consultant will have a 12-h shift. For level 2 and level 3, the patient and caregiver ratio has been kept as 10:1 for doctors and 5:1 for nurses to manage critical patients.[1] The requirement of workforce is shown in [Table 2]a and [Table 2]b below for both scenarios. One hundred-bedded ICU facility includes 20 beds with ventilator. Hence, in ideal scenario, total doctor requirement for 250 beds per day is 108 and 432 per month which will reduced marginally if consultants in level 1 are on-call at night However, in limited resources, it is 54 and 177, respectively. In ideal scenario, 192 paramedical staff are required per day and 104 in resource-limited scenario.


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Personal protective equipment and other requirements

We have also worked on the logistics that are required to run the same facility, as per the guidelines by the Ministry of Health and Family Welfare, Government of India.[2] Since all the consultants will be working for a 12-h shift, they will be given two PPEs[3] so that they can change every 6 h. We have also kept a buffer of 15%–20% equipment to manage damages that may occur while working. As per the guidelines, majority of the PPEs kit are not reusable in the COVID area. However, the cloth scrubs can be reused after washing in accordance with infection control guidelines [Table 3].
Table 3: Total requirement of consumables for 250-bedded facility

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Estimate cost of the consumables

[Table 4] shows estimate cost to the facility. The total cost per day for 250-bedded facility would be ~Rs. 5.65 lakhs and the minimum is Rs. 3.4 lakhs per day, so the corresponding per bed would be Rs. 2261 and Rs. 1360. For 3 months, the total cost should be Rs. 3.58 crores and Rs. 2.16 crores for ideal and minimum scenario. The salary of the staff, staff training/education, and other nonconsumables would be an extra cost.
Table 4: Component costs of the consumables tentative cost of various accessories (present scenario)

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  Discussion Top


Typically, the guidelines issued by the government set out the framework for handling a pandemic situation. However, no guidelines or advisories have been issued to manage the resources (such as the number of consultants, medical officers, nurses, and assistants along with other basic equipment required to handle such crisis). Our article is an attempt to enumerate the resources which would be required by a healthcare facility for effective pandemic preparedness. Based on the requirements of the facility, these resources (with or without modification) should be on standby in an effort to be prepared for the COVID-19 pandemic. The aim was to visualize these two scenarios, i.e., ideal requirement and the minimum requirement in terms of workforce and other consumables. We suggest that the scenario of the ideal requirement should be adopted to protect the healthcare workers and to prevent their exhaustion. The second scenario (i.e., minimum requirement) should only be adopted wherein the number of healthcare professionals is limited. However, we also urge that any facility should not run below the advised numbers as it may lead to burnout among the healthcare workers. We have made an attempt to calculate an approximate amount of fund that would be required to keep the consumables ready for at least 3 months to fight this health hazard. The approximate cost of the consumables required to run a 250-bedded facility is Rs. 5.65 lakhs per day in ideal scenario and the minimum is Rs. 3.4 lakhs per day. In both ideal and human resource-limited scenario, we have calculated the number of PPEs as per the guidelines not compromising the safety of the caregivers.


  Conclusion Top


The pandemic of COVID because of its infectious nature has burdened the healthcare system as well as safety of the caregivers. The economic burden of consumable is far–far less as compared to the requirement of human resources and this challenge is faced globally.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ward N, Bekele A, Ruth K, Samuel T, Michael R, Michael H, et al. Intensivist/patient ratios in closed ICUs: A statement from the Society of Critical Care Medicine Taskforce on ICU Staffing. Crit Care Med 2013;41:638-45.  Back to cited text no. 1
    
2.
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus – Infected pneumonia in Wuhan, China. JAMA 2020;323:1061-9.  Back to cited text no. 2
    
3.
Novel Corona Disease 2019 (COVID 19): Guidelines on Rational Use of Personal Protective Equipment, Ministry of Health and Family Welfare. Available from: https://www.mohfw.gov.in/pdf/GuidelinesonrationaluseofPersonalProtectiveEquipment.pdf. [Last accessed on 2020 Mar 24].  Back to cited text no. 3
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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