Tackling the Waves of COVID-19: A Planning Model for Intrahospital Resource Allocation

Background: The current pandemic requires hospitals to ensure care not only for the growing number of COVID-19 patients but also regular patients. Hospital resources must be allocated accordingly.Objective: To provide hospitals with a planning model to optimally allocate resources to intensive care units given a certain incidence of COVID-19 cases.Methods: The analysis included 334 cases from four adjacent counties south-west of Munich. From length of stay and type of ward [general ward (NOR), intensive care unit (ICU)] probabilities of case numbers within a hospital at a certain time point were derived. The epidemiological situation was simulated by the effective reproduction number R, the infection rates in mid-August 2020 in the counties, and the German hospitalization rate. Simulation results are compared with real data from 2nd and 3rd wave (September 2020–May 2021).Results: With R = 2, a hospitalization rate of 17%, mitigation measures implemented on day 9 (i.e., 7-day incidence surpassing 50/100,000), the peak occupancy was reached on day 22 (155.1 beds) for the normal ward and on day 25 (44.9 beds) for the intensive care unit. A higher R led to higher occupancy rates. Simulated number of infections and intensive care unit occupancy was concordant in validation with real data obtained from the 2nd and 3rd waves in Germany.Conclusion: Hospitals could expect a peak occupancy of normal ward and intensive care unit within ~5–11 days after infections reached their peak and critical resources could be allocated accordingly. This delay (in particular for the peak of intensive care unit occupancy) might give options for timely preparation of additional intensive care unit resources.

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Increase in Pediatric Intensive Care Unit Hospitalizations Due to Toxic Ingestions during the COVID-19 Pandemic

Journal of Pediatric Intensive Care ◽

10.1055/s-0041-1727249 ◽

2021 ◽

Author(s):

Jennifer L. van Helmond ◽

Brittany Fitts ◽

Jigar C. Chauhan

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Home Environment ◽

Clinical Characteristics ◽

Pediatric Intensive Care ◽

Cross Sectional Study ◽

Mitigation Measures ◽

Sectional Study ◽

Cross Sectional

AbstractThe coronavirus disease 2019 (COVID-19) pandemic and related community mitigation measures had a significant psychosocial impact. We suspected that more patients were admitted to our pediatric intensive care unit (PICU) for toxic ingestions since the start of the pandemic. We therefore investigated if PICU admissions related to toxic ingestions were higher in 2020 as a result of COVID-19 compared with previous years. We completed a cross-sectional study at a tertiary children's hospital comparing admissions to our PICU between April 2020 and October 2020, during which COVID-19 and community mitigation measures were in place, to those during the same 7-month period in the previous 3 years. Total PICU admissions, admissions for all toxic ingestions (intentional ingestions and accidental ingestions), and demographic and clinical characteristics of patients were compared. Total PICU admissions in 2020 during COVID-19 pandemic months were lower compared with the same months in the preceding 3 years (−16%, p< 0.001), however, admissions for toxic ingestions were higher during COVID-19 (+64%, p< 0.001). When separated by type, intentional (+55%, p = 0.012) and accidental ingestions (+94%, p = 0.021) were higher during COVID-19. COVID-19 with community mitigation measures has led to an increase in PICU admissions for intentional and accidental ingestions, indicating an increase in severity of toxic ingestions in children associated with the pandemic. Mental health of adolescents, and safety of infants and toddlers in their home environment, should be targeted with specific interventions in the ongoing COVID-19 pandemic.

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Optimized Procedure to Schedule Physicians in an Intensive Care Unit: A Case Study

Mathematics ◽

10.3390/math8111976 ◽

2020 ◽

Vol 8 (11) ◽

pp. 1976

Author(s):

Lotfi Hidri ◽

Achraf Gazdar ◽

Mohammed M. Mabkhot

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Cost Minimization ◽

Optimal Schedule ◽

Real Life ◽

Real Data ◽

Experimental Tests ◽

Operating Costs ◽

Healthcare Personnel ◽

Total Cost

Hospitals are facing an important financial pressure due to the increasing of the operating costs. Indeed, the growth for the hospitals’ services demand causes a rising in the number of required qualified personnel. Enlarging the personnel number increases dramatically the fixed total cost. Based on some studies, 50% of operating costs in US hospitals are allocated to healthcare personnel. Therefore, reducing these types of costs without damaging the service quality becomes a priority and an obligation. In this context, several studies focused on minimizing the total cost by producing optimal or near optimal schedules for nurses and physicians. In this paper, a real-life physicians scheduling problem with cost minimization is addressed. This problem is encountered in an Intensive Care Unit (ICU) where the current schedule is manually produced. The manual schedule is generating a highly unbalanced load within physicians in addition to a high cost overtime. The manual schedule preparation is a time consuming procedure. The main objective of this work is to propose a procedure that systematically produces an optimal schedule. This optimal schedule minimizes the total overtime within a short time and should satisfies the faced constraints. The studied problem is mathematically formulated as an integer linear program. The constraints are real, hard, and some of them are non-classical ones (compared to the existing literature). The obtained mathematical model is solved using a state-of-the-art software. Experimental tests on real data have shown the performance of the proposed procedure. Indeed, the new optimal schedules reduce the total overtime by up to 69%. In addition, a more balanced workload for physicians is obtained and several physician preferences are now satisfied.

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How Hospitals Respond to Wildfires

Eos ◽

10.1029/2021eo158873 ◽

2021 ◽

Vol 102 ◽

Author(s):

Elizabeth Thompson

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Wildfire Smoke ◽

Smoke Pollution ◽

Hospital Resources

A new study tracks intensive care unit admissions after periods of wildfire smoke pollution. A prolonged or severe smoke event has the potential to strain hospital resources.

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Predicted Effects of Stopping COVID-19 Lockdown on Italian Hospital Demand

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2020.157 ◽

2020 ◽

Vol 14 (5) ◽

pp. 638-642 ◽

Cited By ~ 2

Author(s):

Jordy Bollon ◽

Matteo Paganini ◽

Consuelo Rubina Nava ◽

Nello De Vita ◽

Rosanna Vaschetto ◽

...

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Intensive Care ◽

Confidence Interval ◽

Compartmental Model ◽

Mitigation Measures ◽

Surge Capacity ◽

Hospital Intensive Care Unit ◽

Italian Hospital ◽

Hospital Bed

ABSTRACTObjectives:Italy has been one of the first countries to implement mitigation measures to curb the coronavirus disease 2019 (COVID-19) pandemic. There is currently a debate on when and how such measures should be loosened. To forecast the demand for hospital intensive care unit (ICU) and non-ICU beds for COVID-19 patients from May to September, we developed 2 models, assuming a gradual easing of restrictions or an intermittent lockdown.Methods:We used a compartmental model to evaluate 2 scenarios: (A) an intermittent lockdown; (B) a gradual relaxation of the lockdown. Predicted ICU and non-ICU demand was compared with the peak in hospital bed use observed in April 2020.Results:Under scenario A, while ICU demand will remain below the peak, the number of non-ICU will substantially rise and will exceed it (133%; 95% confidence interval [CI]: 94-171). Under scenario B, a rise in ICU and non-ICU demand will start in July and will progressively increase over the summer 2020, reaching 95% (95% CI: 71-121) and 237% (95% CI: 191-282) of the April peak.Conclusions:Italian hospital demand is likely to remain high in the next months. If restrictions are reduced, planning for the next several months should consider an increase in health-care resources to maintain surge capacity across the country.

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Prognosis, Survival, and the Expenditure of Hospital Resources for Patients in an Intensive-Care Unit

New England Journal of Medicine ◽

10.1056/nejm198109173051204 ◽

1981 ◽

Vol 305 (12) ◽

pp. 667-672 ◽

Cited By ~ 163

Author(s):

Allan S. Detsky ◽

Steven C. Stricker ◽

Albert G. Mulley ◽

George E. Thibault

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Resources

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Intensive Care Unit Bed Utilization and Head Injury Burden in a Resource-Poor Setting

The American Surgeon ◽

10.1177/0003134820950282 ◽

2020 ◽

pp. 000313482095028

Author(s):

Abby Wong ◽

Meghan Prin ◽

Laura N. Purcell ◽

Clement Kadyaudzu ◽

Anthony Charles

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Care Center ◽

Tertiary Care ◽

Sub Saharan Africa ◽

Resource Poor Setting ◽

Bed Occupancy ◽

Injury Burden ◽

Occupancy Rates ◽

Bed Occupancy Rates

Introduction In high-income countries (HICs), the intensive care unit (ICU) bed density is approximately 20-32 beds/100 000 population compared with countries in sub-Saharan Africa, like Malawi, with an ICU bed density of 0.1 beds/100 000 population. We hypothesize that the ICU bed utilization in Malawi will be high. Methods This is an observational study at a tertiary care center in Malawi from August 2016 to May 2018. Variables used to evaluate ICU bed utilization include ICU length of stay (LOS), bed occupancy rates (average daily ICU census/number of ICU beds), bed turnover (total number of admissions/number of ICU beds), and turnover intervals (number of ICU bed days/total number of admissions – average ICU LOS). Results 494 patients were admitted to the ICU during the study period. The average LOS during the study period was 4.8 ± 6.0 days. Traumatic brain injury patients had the most extended LOS (8.7 ± 6.8 days) with a 49.5% ICU mortality. The bed occupancy rate per year was 74.7%. The calculated bed turnover was 56.5 persons treated per bed per year. The average turnover interval, defined as the number of days for a vacant bed to be occupied by the successive patient admission, was 1.63 days. Conclusion Despite the high burden of critical illness, the bed occupancy rates, turn over days, and turnover interval reveal significant underutilization of the available ICU beds. ICU bed underutilization may be attributable to the absence of an admission and discharge protocols. A lack of brain death policy further impedes appropriate ICU utilization.

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The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_persp-19-00097 ◽

2019 ◽

Vol 4 (6) ◽

pp. 1507-1515

Author(s):

Lauren L. Madhoun ◽

Robert Dempster

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Hospital Discharge ◽

Neonatal Intensive Care ◽

Oral Feeding ◽

Medical Attention ◽

Primary Role ◽

Speech Language Pathologists ◽

The Family

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.

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