RADBOUD University Medical – COVID-19 from an Academic Hospital’s Perspective

On February 27, 2020, the first patient with a SARS-CoV-2 infection was confirmed in the Netherlands. Subsequently, the number of infected people and hospital admissions in the Netherlands increased rapidly, also at Radboudumc.

First COVID-19 wave: crisis organization

The dedicated Crisis Management Team (CMT) was already active in late February 2020; upscaling started a week prior to the first patient as part of the preparedness plan. The first COVID-19 patient was admitted to the Radboudumc on 5 March 2020. In that same week, the dedicated ‘crisis organization’ was fully scaled up and operational and included the following crisis teams: Infection Prevention and Outbreak Response, COVID-19 healthcare, Logistics and Facility Services, Information Management, Communication. The CMT guided and coordinated these teams, organizing COVID-19 patient care into cohorts, scaling down regular patient care and business processes (e.g. education and research), managing the supply of personal protective equipment (PPE). It was also responsible for coordinating patient flow in the region (ROAZ, Regional Consultation Emergency Care Chain) and worked together with the National Patient Distribution Coordination. This coordination structure was a unique national coordinating structure, that coordinated national distribution of COVID-19 patients with the objective to distribute the burden equally between all hospitals despite distance and regional difference. The dedicated crisis organization structure was permanently active from March through June 2020.

Quick response

Early March 2020, Radboudumc had quickly set up a COVID-19 testing facility for employees in-house. This was very helpful, especially because the test result was available the same day which meant that healthcare workers whose PCR for SARS-CoV-2 was negative, were available for patient care very quickly.

In the first weeks of the pandemic, a dashboard with management information at hospital level was developed. Radboudumc also continuously provided data for the monitoring and registration of COVID-19 hospital admissions which was coordinated by the National Intensive Care Evaluation (NICE). Despite working with an electronic patient record system (EPIC), data has to be retrieved from multiple systems and data sources, not fully automated and therefore labor-intensive.

On May 26, 2020, after the first wave, our dedicated crisis organization was de-activated and regular hospital management took over again scaling up regular patient care, education and research and started preparing for a possible second wave of COVID-19 care. From that moment, Radboudumc continuously adapted the organization based on the requirements demanded by the forecasts for the COVID-19 and other (regular) care. At the end of May 2020, it was decided that the regular hospital management organization would be responsible for the pandemic and its consequences, while the CMT remained on standby. An auxiliary structure was then set up, the Central Coordinating Team (CCT). This CCT ensured the organization, distribution and allocation of clinical capacity (for COVID and non-COVID care in the short and long(er) term). Also, the central coordination of Radboudumc-wide activities arising from the COVID measures (e.g. design of the physical environment, communication, roll-out of a vaccination program). A number of action teams were involved; they were requested to investigate and carry out assignments. These teams included care, infection outbreak, research, education, communication, design and digital support.

Integral capacity management

Even before the COVID-19 pandemic, the Radboudumc had implemented integral capacity management (ICM) models to ensure flow of patients within the hospital. During the COVID-19 pandemic ICM was given a prominent role to manage the capacity of beds and staff and to keep a good grip on both COVID and non-COVID patient flow in the short and long(er) term. With this sound management of the capacity of beds and staff we were able to ensure that both COVID and regular patients were given the best care possible, in the appropriate departments with as little delay as possible.

Guidance

The various members of the Radboudumc PANDEM-2 team saw it as their responsibility to make sure that communication about the pandemic, the virus, the vaccines, the measures and the consequences and impact of covid-19 for and on vaccinated and unvaccinated patients was clear, correct and focused on decompressing fake news and confusion. They did this by giving interviews to the (inter)national press, working together with the Communications department to write explanatory messages for the website and by participating in panel discussions on the topic.

In addition, they were asked to participate in and join think tanks that were set up at national level, as well as working together in international bodies such as WHO IPC to e.g. draw up guidelines etc.

About the Radboudumc

The Radboudumc is one of seven academic medical centers in the Netherlands, with approximately 11,000 employees and 609 hospital beds. The Radboudumc aims to have a significant impact on healthcare by providing excellent quality of care and research with a focus on participatory and personalized healthcare, operational excellence and sustainable networks. The Radboudumc is represented in de PANDEM-2 project by Infectious Diseases specialist and professor Outbreaks of Infectious Diseases Chantal Bleeker, clinical microbiologist and medical director of the department Quality & Safety Joost Hopman and epidemiologist and assistant professor Infection Prevention Control Alma Tostmann. The different backgrounds in the team provide a wide range of knowledge, experience and practical insight to support the development and implementation of the programs and systems to be put in place as a result of the PANDEM-2 project.