Strategies for managing surge capacity: increasing hospital capacity
Converting wards typically used for other reasons into COVID-19 treatment wards
Cancelling elective procedures and surgeries (at least 1 week prior to patient surge)
Shifting outpatient appointments to other times or settings. This may be particularly useful for chronic disease, for example
Community Health Workers (CHWs) distribute medication refills
Phone or text messaging for virtual appointments instead of in-person consultation
Consider increasing the time duration between follow up visits for stable patients; ensure they are given sufficient quantities of medications until their next visit
Shift non-COVID-19 inpatients to alternate treatment sites, for example:
Malnutrition treatment to health centres or local community settings or CHW supported
Transition patients on long courses of antibiotics to oral antibiotics and discharge home
Move all routine hospital outpatient visits (e.g. antenatal care, under 5s) to primary care centres to repurpose outpatient space for inpatient or isolation beds
Identify alternate treatment sites for mild cases (churches, hotels, schools, etc.) with local authorities
If several beds can be freed from each ward, wards can be combined to create an empty space for COVID-19 treatment
These approaches require a multidisciplinary team, including physicians, nurses, midwives, CHWs, facilities managers, and hospital administration
Allocation of advanced care services may become necessary for treatment such as oxygen therapy or ventilation. There are two key recommendations to consider:
Plan in advance: This is critical to ensure equity and to protect staff from making very difficult decisions without support
Focus on saving the most amount of lives and likelihood of survival from COVID-19: Allocation systems which incorporate factors such as age, gender, social or economic characteristics, or other illnesses may lead to inequity and be difficult to apply. In addition, some of these (e.g. age) will already impact likelihood of survival and therefore are inherently included
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