The disaster task force medical officer as a pivotal decision maker in the superordinate pandemic hospital capacity management : A field report covering the initial COVID-19 surge in a Bavarian district
BACKGROUND AND OBJECTIVE: During the initial phase of the COVID-19 pandemic the government of the state of Bavaria, Germany, declared a state of emergency for its entire territory for the first time in history. Some areas in eastern Bavaria were among the most severely affected communities in Germany, prompting authorities and hospitals to build up capacities for a surge of COVID-19 patients. In some areas, intensive care unit (ICU) capacities were heavily engaged, which occasionally made a redistribution of patients necessary.
MATERIAL AND METHODS: For managing COVID-19-related hospital capacities and patient allocation, crisis management squads in Bavaria were expanded by disaster task force medical officers ("Ärztlicher Leiter Führungsgruppe Katastrophenschutz" [MO]) with substantial executive authority. The authors report their experiences as MO concerning the superordinate patient allocation management in the district of Upper Palatinate (Oberpfalz) in eastern Bavaria.
RESULTS: By abandoning routine patient care and building up additional ICU resources, surge capacity for the treatment of COVID-19 patients was generated in hospitals. In parts of the Oberpfalz, ICU capacities were almost entirely occupied by patients with corona virus infections, making reallocation to other hospitals within the district and beyond necessary. The MO managed patient pathways in an escalating manner by defining local (within the region of responsibility of a single MO), regional (within the district), and cross-regional (over district borders) reallocation lanes, as needed. When regional or cross-regional reallocation lanes had to be established, an additional management level located at the district government was involved. Within the determined reallocation lanes, emitting and receiving hospitals mutually agreed on any patient transfer without explicitly involving the MO, thereby maintaining the established interhospital routine transfer procedures. The number of patients and available treatment resources at each hospital were monitored with the help of a web-based treatment capacity registry. If indicated, reallocation lanes were dynamically revised according to the present situation. To oppose further virus spreading in nursing homes, the state government prohibited patient allocation to these facilities, which led to considerably longer hospital length of stay of convalescent elderly and/or dependent patients. In parallel to the flattening of the COVID-19 incidence curve, routine hospital patient care could be re-established in a stepwise manner.
CONCLUSION: Patient allocation during the state of emergency by the MO sought to keep up routine interhospital reallocation procedures as much as possible, thereby reducing management time and effort. Occasionally, difficulties were observed during patient allocations crossing district borders, if other MO followed different management principles. The nursing home blockade and conflicting financial interests of hospitals posed challenges to the work of the disaster task force medical officers.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2021 |
|---|---|
| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:70 |
|---|---|
| Enthalten in: |
Der Anaesthesist - 70(2021), 7 vom: 01. Juli, Seite 582-597 |
| Sprache: |
Deutsch |
|---|
| Weiterer Titel: |
Der Ärztliche Leiter Führungsgruppe Katastrophenschutz als zentrale Entscheidungsinstanz bei der Steuerung regionaler Krankenhauskapazitäten in der Pandemie : Ein Erfahrungsbericht zur ersten Welle der COVID-19-Pandemie in einem bayerischen Regierungsbezirk |
|---|
| Beteiligte Personen: |
Dittmar, Michael S [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
COVID-19 |
|---|
| Anmerkungen: |
Date Completed 15.07.2021 Date Revised 30.04.2022 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1007/s00101-020-00911-6 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM319914003 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM319914003 | ||
| 003 | DE-627 | ||
| 005 | 20231225172449.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2021 xx |||||o 00| ||ger c | ||
| 024 | 7 | |a 10.1007/s00101-020-00911-6 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1066.xml |
| 035 | |a (DE-627)NLM319914003 | ||
| 035 | |a (NLM)33427914 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a ger | ||
| 100 | 1 | |a Dittmar, Michael S |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The disaster task force medical officer as a pivotal decision maker in the superordinate pandemic hospital capacity management |b A field report covering the initial COVID-19 surge in a Bavarian district |
| 246 | 3 | 3 | |a Der Ärztliche Leiter Führungsgruppe Katastrophenschutz als zentrale Entscheidungsinstanz bei der Steuerung regionaler Krankenhauskapazitäten in der Pandemie : Ein Erfahrungsbericht zur ersten Welle der COVID-19-Pandemie in einem bayerischen Regierungsbezirk |
| 264 | 1 | |c 2021 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 15.07.2021 | ||
| 500 | |a Date Revised 30.04.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND AND OBJECTIVE: During the initial phase of the COVID-19 pandemic the government of the state of Bavaria, Germany, declared a state of emergency for its entire territory for the first time in history. Some areas in eastern Bavaria were among the most severely affected communities in Germany, prompting authorities and hospitals to build up capacities for a surge of COVID-19 patients. In some areas, intensive care unit (ICU) capacities were heavily engaged, which occasionally made a redistribution of patients necessary | ||
| 520 | |a MATERIAL AND METHODS: For managing COVID-19-related hospital capacities and patient allocation, crisis management squads in Bavaria were expanded by disaster task force medical officers ("Ärztlicher Leiter Führungsgruppe Katastrophenschutz" [MO]) with substantial executive authority. The authors report their experiences as MO concerning the superordinate patient allocation management in the district of Upper Palatinate (Oberpfalz) in eastern Bavaria | ||
| 520 | |a RESULTS: By abandoning routine patient care and building up additional ICU resources, surge capacity for the treatment of COVID-19 patients was generated in hospitals. In parts of the Oberpfalz, ICU capacities were almost entirely occupied by patients with corona virus infections, making reallocation to other hospitals within the district and beyond necessary. The MO managed patient pathways in an escalating manner by defining local (within the region of responsibility of a single MO), regional (within the district), and cross-regional (over district borders) reallocation lanes, as needed. When regional or cross-regional reallocation lanes had to be established, an additional management level located at the district government was involved. Within the determined reallocation lanes, emitting and receiving hospitals mutually agreed on any patient transfer without explicitly involving the MO, thereby maintaining the established interhospital routine transfer procedures. The number of patients and available treatment resources at each hospital were monitored with the help of a web-based treatment capacity registry. If indicated, reallocation lanes were dynamically revised according to the present situation. To oppose further virus spreading in nursing homes, the state government prohibited patient allocation to these facilities, which led to considerably longer hospital length of stay of convalescent elderly and/or dependent patients. In parallel to the flattening of the COVID-19 incidence curve, routine hospital patient care could be re-established in a stepwise manner | ||
| 520 | |a CONCLUSION: Patient allocation during the state of emergency by the MO sought to keep up routine interhospital reallocation procedures as much as possible, thereby reducing management time and effort. Occasionally, difficulties were observed during patient allocations crossing district borders, if other MO followed different management principles. The nursing home blockade and conflicting financial interests of hospitals posed challenges to the work of the disaster task force medical officers | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Disaster medicine | |
| 650 | 4 | |a Patient transfer | |
| 650 | 4 | |a SARS-CoV-2 | |
| 650 | 4 | |a Surge capacity | |
| 700 | 1 | |a Altmeppen, Jürgen |e verfasserin |4 aut | |
| 700 | 1 | |a Bigalke, Marc U |e verfasserin |4 aut | |
| 700 | 1 | |a Niedermirtl, Florian |e verfasserin |4 aut | |
| 700 | 1 | |a Zimmermann, Markus |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Der Anaesthesist |d 1952 |g 70(2021), 7 vom: 01. Juli, Seite 582-597 |w (DE-627)NLM00001253X |x 1432-055X |7 nnns |
| 773 | 1 | 8 | |g volume:70 |g year:2021 |g number:7 |g day:01 |g month:07 |g pages:582-597 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1007/s00101-020-00911-6 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 70 |j 2021 |e 7 |b 01 |c 07 |h 582-597 | ||