Description of an Integrated and Dynamic System to Efficiently Deal With a Raging COVID-19 Pandemic Peak

Vanni Agnoletti; Emiliano Gamberini; Alessandro Circelli; Costanza Martino; Domenico Pietro Santonastaso; Giuliano Bolondi; Giorgia Bastoni; Martina Spiga; Paola Ceccarelli; Luca Montaguti; Fausto Catena; Venerino Poletti; Carlo Lusenti; Claudio Lazzari; Mattia Altini; Emanuele Russo

doi:10.3389/fmed.2022.819134

Description of an Integrated and Dynamic System to Efficiently Deal With a Raging COVID-19 Pandemic Peak

Front Med (Lausanne). 2022 Mar 18:9:819134. doi: 10.3389/fmed.2022.819134. eCollection 2022.

Authors

Vanni Agnoletti¹, Emiliano Gamberini¹, Alessandro Circelli¹, Costanza Martino¹, Domenico Pietro Santonastaso¹, Giuliano Bolondi¹, Giorgia Bastoni², Martina Spiga², Paola Ceccarelli², Luca Montaguti³, Fausto Catena⁴, Venerino Poletti⁵, Carlo Lusenti⁶, Claudio Lazzari⁶, Mattia Altini⁷, Emanuele Russo¹

Affiliations

¹ Department of Emergency Surgery and Trauma, Anesthesia and Intensive Care Unit, M Bufalini Hospital, Cesena, Italy.
² Nursing Department, M Bufalini Hospital, Cesena, Italy.
³ Department of Internal Medicine, M Bufalini Hospital, Cesena, Italy.
⁴ Department of Emergency Surgery and Trauma, M Bufalini Hospital, Cesena, Italy.
⁵ Department of Respiratory Diseases, AUSL Romagna-Morgagni Hospital, Forlì, Italy.
⁶ Hospital Direction M Bufalini Hospital, Cesena, Italy.
⁷ Hospital Direction Azienda Unità Sanitaria Locale della Romagna, Ravenna, Italy.

Abstract

Background: This study aimed to describe an innovative and functional method to deal with the increased COVID-19 pandemic-related intensive care unit bed requirements.

Methods: We described the emergency creation of an integrated system of internistic ward, step-down unit, and intensive care unit, physically located in reciprocal vicinity on the same floor. The run was carried out under the control of single intensive care staff, through sharing clinical protocols and informatics systems, and following single director supervision. The intention was to create a dynamic and flexible system, allowing for rapid and fluid patient admission/discharge, depending on the requirements due to the third Italian peak of the COVID-19 pandemic in March 2021.

Results: This study involved 142 COVID-19 patients and 66 non-COVID-19 patients who were admitted; no critical patient was left unadmitted and no COVID-19 severe patients referring to our center had to be redirected to other hospitals due to bed saturation. This system allowed shorter hospital length-of-stay in general wards (5.9 ± 4 days) than in other internistic COVID-19 wards and overall mortality in line with those reported in literature despite the peak raging.

Conclusion: This case report showed the feasibility and the efficiency of this dynamic model of hospital rearrangement to deal with COVID-19 pandemic peaks.

Keywords: COVID-19; bed management; bed occupancy rate; high dependency unit; hospital admission criteria; intensive care unit; patients throughput; step-down unit.