Flexible hospital design key for future pandemics

The study we undertook aimed to identify important infrastructural adaptations that were undertaken by the hospitals in question in response to increasing number of COVID-19 patient admissions during the surge phase of the pandemic. We studied 257 hospitals that responded to a questionnaire about the infrastructural adaptations they made during the pandemic — in areas ranging from facilities management, management of medical equipment, and human resources management, to management of beds for emergency COVID-19 patients. We also questioned them about the hospital features and clinical activities for both non-COVID and COVID-19 patients between 2019 and 2020.

We statistically analysed the important explanatory variables for increasing the number of COVID-19 patient admissions, using a multivariate logistic model, followed by a stepwise procedure. The possible explanatory variables were selected beforehand by univariate analysis. The accommodation capacity was defined as the number of admissions of COVID-19 patients adjusted by the number of nurses.

Three infrastructural adaptations emerged as important explanatory variables for increasing the accommodation capacity for COVID-19 patients: mandatory securing of beds for COVID-19 patients (odds ratio [OR] 10.24, 95% confidence interval [CI] 4.79-21.85, P<0.000), additional purchase of ventilators (OR 2.46, 95%CI 1.28-4.73, P=0.007), and installation of negative pressure rooms
(OR 3.84, 95%CI 1.68-8.78, P=0.001). As regards infection clusters, a large increase in the accommodation capacity was selected as a single explanatory variable (OR 9.45, 95%CI 3.16-28.24, P=0.00006).