Abstract
The present paper is a review of the main challenges faced by the management of a tertiary specialty hospital during the COVID-19 pandemic in the northern Italian region of Lombardy, an area of extremely high epidemic impact. The article focuses on the management of patient flows, access to the hospital, maintaining and reallocating staffing levels, and managing urgent referrals, information, and communications from the point of view of the hospital managers over a seven-week period. The objective of the article is to provide beneficial insights and solutions to other hospital managers and medical directors who should find themselves in the same or a similar situation. In such an epidemic emergency, in the authors’ opinion, the most important factors influencing the capability of the hospital to maintain operations are (1) sustaining the strict triage of patients, (2) the differentiation of flows and pathways to create what could be regarded as “a hospital inside a hospital”, (3) tracing and sharing all available information to face the rapidly changing environment, (4) being able to maintain staffing levels in critical areas by flexibly allocating the workforce, and (5) from a regional perspective, being organized along a hub-and-spoke system for critical and time-sensitive networks was key for focusing the hospital’s resources on the most needed services.
Highlights
Istituto Ortopedico Galeazzi is a 364 bed multispecialty private orthopedic hospital in Milan, in the northern Italian region of Lombardy, which delivers care to the public on behalf of the national payor
The COVID-19 epidemic placed a particular strain on the human resources of the hospital in many ways and we identify what we believe to be the three main ways in which this strain was exerted
Given the were staffed around the clock by a team of four physiatrists, four cardiologists, two neurosurgeons, radical change in the case mix, all of the medical staff who could not be used in their normal function two neurologists, two dermatologists, one vascular surgeon, two maxillofacial surgeons, two pain therapists, and five to seven orthopedic surgeons. These were employees of the hospital, as well as doctors holding a freelance contract with the hospital who volunteered to do shifts on the COVID-19 units
Summary
Istituto Ortopedico Galeazzi is a 364 bed multispecialty private orthopedic hospital in Milan, in the northern Italian region of Lombardy, which delivers care to the public on behalf of the national payor. Galeazzi performs about 17,000 surgical operations every year, and is the hospital which performed the highest number joint replacement surgeries in the country (approximately 4000 in 2019). While Galeazzi was previously a hospital mostly dedicated to elective orthopedic surgical cases (93% of admissions were elective and only 7% were urgent admissions between February and April of 2019) (Table 1) at the height of the epidemic, the hospital became dedicated exclusively to: Int. J. The events are contained in a seven-week period ranging from Monday 24 February to Sunday 12 April 2020, the day on which this article was started, encompassing the peak of the epidemic phase in the region [5]
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