Switch points exist at which hospitals must introduce strategies for increasing capacity or fully dedicate to COVID-19 response to meet COVID-19 surge demand
Two key switch points can aid a hospital in coping with increasing COVID-19 patient demand, the first of which uses alternative standards of care (ASCs) (increased patient-to-staff ratios permitted and repurposing of nonmedical space) and the second designates nearly all medical space and staff for COVID-19 treatment. ASCs are needed at COVID-19 daily patient arrivals of 20 and full hospital designation at 70 arrivals. Implementing ASCs allows the hospital to serve, on average, 30 COVID-19 patient arrivals per day (~10 additional patients or 33% 
increase based on ICU). Dedicating the hospital to COVID-19 patients along with ASCs would allow the hospital to serve an average of 40 more COVID-19 patient arrivals per day in the isolation rooms (a 133% increase) and an average of 80 more in the ICU (a 400% increase). With additional negative pressure rooms for isolation and critical care nurses, the designated hospital could serve even higher numbers.
The base model replicated a typical US urban 200-bed tertiary hospital with:
- 100 daily routine patient arrivals
- 20 ICU beds shared between COVID-19 and routine patient arrivals
- 20 ED beds and 25 critical decision unit beds (converted from 40 ED beds)
- 70 isolation rooms (taking 50 of the internal general ward (IGW) beds)
- 150 IGW beds
- Separate COVID-19 entry
- 10% COVID-19 patients to ICU with average 9-day stay in ICU (2.8 realized average ICU stay for routine patients)
Comparison model with ASCs:
- 100 daily routine patient arrivals
- 25 ICU beds shared between COVID-19 and routine patient arrivals
- 20 ED beds and 25 critical decision unit beds (converted from 40 ED beds)
- 105 isolation rooms (taking 50 of the internal general ward (IGW) beds)
- 225 IGW beds
- Separate COVID-19 entry
- 10% COVID-19 patients to ICU with average 9-day stay in ICU (2.8 realized average ICU stay for routine patients)
- Doctors and nurses ratios to patients in isolation rooms and ICU are doubled compared to the base case
- Assumed full at 0.98 utilization
Comparison hot spot models:
- Hot Spot Design - Staff and space in Pre-op, SICU, PACU and 75% ED reassigned for ICU COVID-19 patients and in General Ward, Stepdown and 25% ED to admitted COVID-19 patients needing isolation
- Hot Spot Design with Crisis Standards of Care - Nurses and doctors serve twice the patients as compared to routine standards of care
- Hot Spot Design with Optimized Staff Assignment - Reallocated staff are optimally assigned based on expected utilization and skills, routine standards of care are maintained
COVID-19 Care Paths & Assumptions (pdf)