Hospital Readiness in Several Countries in Dealing with COVID-19 Pandemic: A Systematic Review

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DOI: http://dx.doi.org/10.33846/hn60409 http://heanoti.com/index.php/hn

RESEARCH ARTICLE

URL of this article: http://heanoti.com/index.php/hn/article/view/hn60409

Hospital Readiness in Several Countries in Dealing with COVID-19 Pandemic:

A Systematic Review

Siti Riri Shafira^1(CA), Anhari Achadi²

1(CA)Master Program in Public Health, Faculty of Public Health, Universitas Indonesia, Indonesia;

siti.riri@ui.ac.id (Corresponding Author)

2 Department of Health Policy and Administration, Faculty of Public Health, Universitas Indonesia, Indonesia;

aachadi@gmail.com

ABSTRACT

The current COVID-19 pandemic has made the world face the most difficult situation in this decade. Millions of people infected with COVID-19 are of concern to the medical world. The role of the hospital is not spared from this, a place for treatment and infection control. Hospital readiness is very important to respond effectively to this pandemic. The purpose of this systematic review is to find out how far the current hospital readiness in dealing with the COVID-19 pandemic. The analysis was guided by the Rapid Hospital Readiness Checklist developed by WHO to identify preparation and preparedness response to the pandemic that consisted of 12 components i.e leadership, coordination, surveillance, risk communication, patient surge, administration, human resources, primary care, patient management, occupational safety, diagnosis, and infection prevention. The method used was systematic review using PRISMA and search articles through ScienceDirect, Scopus, and Proquest using the keywords "Hospital Readiness and COVID-19". Then the article was analyzed based of the research results of the article on the content. From the selected articles, it is explained that the readiness of hospitals in dealing with the pandemic is still relatively low. The absence of plan development, as well as gaps in human resources, equipment, infrastructure, processes, staff training, and procedures in hospitals, have caused delays in hospital readiness in dealing with the COVID-19 pandemic. requires evaluation and support from the community and government as well as improving the health system in order to increase hospital readiness in dealing with COVID-19 pandemic Keywords: hospital readiness; COVID-19; primary care; WHO checklist

INTRODUCTION Background

Since 2019 until now, the world is faced with the COVID-19 pandemic which has infected millions of people around the world every day, there are always increasing cases. COVID-19 is transmitted through droplets with COVID-19 symptoms that are non-specific and can be asymptomatic to severe pneumonia and cause death.

Specific signs and symptoms are noted such as dry cough, fever, fatigue, phlegm production, shortness of breath, sore throat, dizziness, chills, nausea, diarrhea, dizziness, nasal congestion, arthralgia myalgia, hemoptysis, and conjunctival congestion ⁽¹⁾. In Indonesia as of January 2022, there were 4,263,168 million confirmed cases of COVID-19 and 144,097 reported deaths ⁽²⁾. Indonesia is the country with the 14th highest number of COVID-19 cases worldwide ⁽³⁾.

The COVID-19 pandemic has reviewed public health systems globally ⁽⁴⁾. Some are serious about responding to COVID-19 even in advanced health care systems ⁽⁵⁾. Health services are under pressure from the new challenges caused by COVID-19 and must make difficult choices in maintaining access to essential health services while working to treat new infectious diseases ⁽⁶⁾. Prioritizing is an important key step in providing the necessary support ⁽⁷⁾. To facilitate an effective response, an emergency response committee was created to develop measures in all sectors where initial steps were taken to limit the spread of COVID-19. Collaborative teamwork from many sectors with clear roles and responsibilities is the cornerstone to contain the spread of the COVID-19 pandemic ⁽⁸⁾. If cooperation and support are not implemented, then the implementation will not be successful ⁽⁹⁾.

Health care is always hopeful and could be an area of potential yield unless adequate prevention systems are established ⁽¹⁰⁾. COVID-19 readiness in health services is a top priority to protect health workers, protect at- risk groups, reduce demand for special health services, and spread the pandemic to other health facilities and the community ⁽¹¹⁾.

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Hospitals have an important role in providing health services. It is important to recognize that the pandemic will disrupt established hospital management practices for an indefinite period time so critical changes must be implemented ⁽¹²⁾. The COVID-19 pandemic has had a strong impact on hospital operations and medical practice worldwide ⁽¹³⁾.

In the face of the COVID-19 pandemic, WHO developed the Rapid Hospital Readiness Checklist and the accompanying tools. The tool is designed to help assess a hospital's overall readiness and determine the priority courses of action to be taken to prepare for and respond to a pandemic. This tool is part of a broader assessment of healthcare pricing in the context of the COVID-19 pandemic. This monitoring tool focuses on various important aspects of maintaining essential healthcare services while keeping the COVID-19 situation under control ⁽⁴⁾.

Hospitals have many challenges during a pandemic so they need to start preparations for dealing with a pandemic and admitting patients so that they need the right tools to activate the readiness and completion functions and increase strength ⁽¹⁴⁾. So hospitals need to be evaluated by using a tool to know the readiness in dealing COVID-19 pandemic.

The readiness of hospitals to develop key structures and processes to adapt to changing health care environments is an example of innovation in the current crisis (15).

METHODS

The method used in this research was systematic review using PRISMA. Data was obtained from research articles by accessing ScienceDirect, Scopus, and Proquest.

Search for research articles using the keywords “Hospital Readiness and COVID-19”. The articles obtained were read carefully to determine whether they met the inclusion criteria. The inclusion criteria used were research articles published from 2020-2021, open access, and English. Meanwhile, the exclusion criteria in this study were research articles that were outside the topic of hospital readiness during the C0VID-19 pandemic.

Research articles were found after using “Hospital Readiness and COVID-19” keywords from 3 sources.

Then the articles were selected and removed the unsuitable article from the list. The final stage was to screen articles that meet the criteria based on the title, abstract, and content of the article. The number of articles used was seven that were relevant to this study and included in a systematic review.

RESULTS

From the results, total of 1,572 research articles were found by searching from three databases, then separates from similar articles, and also selects titles, abstracts and using Rapid Hospital Readiness Checklist.

There were seven articles that met the appropriate criteria and were included in the analysis.

Figure 1. PRISMA flow diagram Articles identified through database

searching

Scopus = 120; Science Direct = 44;

ProQuest = 1.408

Full text articles assessed for eligibility

Articles screened 555 duplicate articles removed

Final eligible articles (n=7)

Records after duplicates removed (n = 1.017)

IdentificationScreeningIncluded

925 articles excluded

Eligibility

85 articles excluded

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The seven articles that discuss overview of hospital readiness were studies from various countries in the world, they are Ethiopia, Italy, Iran, Egypt, Nigeria, Idaho, Lebanon.

From the seven articles reviewed, it is known that there are still many hospitals that are not ready to face the COVID-19 pandemic. Hospitals are constrained and have low scores in the hospital readiness assessment ⁽¹⁶⁾

(17, 18). As well as the challenges faced by hospitals such as communication and information management and the availability of resources (19, 20, 21, 22).

Table 1. Articles search results

No. Author Tittle Place Design Result Conclusion

1 Tiruneh (2020)

(16)

A cross- sectional survey of COVID-19 preparedness in

governmental hospitals of North-West Ethiopia

Ethiopia Cross- sectional

Of the 8 hospitals, 50% hospital meet the required score, 1 hospital was in the ready level of preparation (>146 points), 3 hospitals in the inadequate preparation level (73-145 points), and 4 other hospitals were grouped under the unprepared level (<72 points) against COVID-19. All hospitals do not have laboratories for the diagnosis and treatment of COVID-19.

From the level of readiness for the COVID-19 pandemic from 8 hospitals, only 1 hospital reached an acceptable level of readiness. To reduce the impact of COVID- 19, it is recommended that the community and government equip hospitals with resources and make priorities.

2 Sorbello (2021)

(19)

After Action Reviews of COVID‐19 response:

Case study of a large tertiary care hospital in Italy

Italy Case study

The evaluated hospital response was declared effective and responsive. Respondents emphasized the relationship between:

strong governance and coordination

readiness and presence of health workers

the model of care is based on a multidisciplinary approach.

The challenges faced were communication management and staff training.

This study is one of the first applications of AAR in response to COVID-19 in hospitals, which was successfully adapted for the

implementation of preparedness strategies for future public health emergencies.

3 Nazari (2021)

(18)

Survey Hospitals Preparedness and

Resilience in Crisis COVID-19 in the South of Kerman Province, Iran

Iran Cross- sectional

The highest level was 54.9%

and the lowest was 1.2% in the readiness to identify and treat patients and communication facilities. overall, 43% ready, 52% towards ready, and 3% not ready. The average value of resilience is 194.37±41.40. The level of the main vulnerability component (70.47±16.68) p.

Pearson correlation coefficient showed no relationship between readiness and resilience

(p>0.05).

Hospital resilience is moderate, hospital readiness is low. So it is necessary to improve the health system to help improve continuing education programs,

psychological support, and planning and decision making to control the pandemic.

4 Labib (2020)

(20)

Hospital Preparedness for Critical Care during COVID-19 Pandemic:

Exploratory Cross-

Egypt Cross- sectional

Readiness in the ICU for children and adults is 54%.

However, adult ICU is better prepared than pediatric ICU, especially in communication, essential services and surge capacity, identification, diagnosis, isolation, and case management. Both are

This study describes ICU readiness, further assessment is needed during different phases of the pandemic. There should be continuing education for health workers and active communication.

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No. Author Tittle Place Design Result Conclusion

sectional Study

comparable in operational support, logistics and supply management, human resources;

and infection prevention and control, while information is lower in both types but scores at 10% in adults.

5 Ogoina (2021)

(17)

A national survey of hospital readiness during the COVID-19 pandemic in Nigeria

Nigeria Cross- Sectional

Among the 20 hospitals, readiness scores were 28.2% to 88.7% (median 68.4%), and 3 (15%) hospitals were prepared.

They had an average of 15 beds for isolation, 4 beds ICU and 4 ventilators per hospital, but over 45% of hospitals set up isolation facilities and provided ventilators when COVID-19 emerged. Of the 13 readiness components, the lowest readiness scores were reported for surge capacity (61.1%), human resources (59.1%), staff health (50%) and, availability of essential goods (47.7%).

Most hospitals in Nigeria are not adequately prepared to deal with the COVID- 19 pandemic. Efforts to strengthen hospital preparedness must prioritize challenges regarding capacity surges, critical care for COVID-19 patients, and staff health and protection.

6 Kanwar (2020)

(22)

A Survey of COVID-19 Preparedness Among Hospitals in Idaho

Idaho Cross- sectional

32 (73%) hospitals filled out the survey. Participating hospitals report readiness to control COVID-19 as well as the availability of resources, for example, isolation rooms and personal protective equipment, to safely manage suspected and confirmed COVID-19 cases.

Hospitals have varying degrees of readiness to control COVID-19.

While the study highlights strengths, including the

application of infection control and emergency management

framework, it also highlights other areas, such as consistency in implementation based on guidelines and the need for infection prevention as potential areas for strengthening preparedness for the COVID-19 pandemic.

7 Zeenny (2020)

(21)

Assessing knowledge, attitude, practice, and

preparedness of hospital pharmacists in Lebanon towards COVID-19 pandemic: a cross- sectional study

Lebanon Cross- sectional

Respondents know > 90% of knowledge questions regarding COVID-19. Most of the respondents were worried about being infected and transmitting it to their families. A total of 67% complied with safety advice. Most of the respondents agreed that there was a

shortage, rising prices, and late supplies of masks and cleaning kits. In COVID-19 readiness, 50% of hospitals have implemented the necessary steps.

The level of knowledge and practice is already good on COVID-19.

National organizations could take advantage of leveraging the skills of hospital pharmacists to reduce emergencies in the event of a further wave of COVID-19.

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DISCUSSION

The articles obtained show an overview of hospital readiness from various countries in the world like Ethiopia, Italy, Iran, Egypt, Nigeria, Idaho, Lebanon. The study conducted in Ethiopia clarifies that all hospitals received more than 50% of the required score and only one hospital received full marks in accordance with WHO provisions in the components of the disaster management system. In the surge capacity, the main problem is the availability of equipment in hospitals, namely ventilation, intensive care unit (ICU), and beds, expansion of hospital inpatient capacity. Then the hospital has also realized the importance of sanitation during the pandemic and the implementation of overall vigilance but not optimal in the availability of personal protective equipment, rooms that have proper ventilation, placing patients in isolation rooms, minimizing patients moving from one room to another, and recording visitors. patient. Case management does not apply because there are no COVID- 19 cases handled in the hospital but the hospital knows the guidelines for handling COVID-19, the officers also know about COVID-19 and have a triage system but there is no triage supervisor at the hospital and other medical equipment, tools are also not sufficient. For human resources, all hospital staff has been given training on COVID- 19 handling, staff planning and renewal, working time arrangements but the components for staff guidance regarding the formation of the disaster management team system have not been updated and the identification of the optimal number of staff to continue to provide health service does not exist. Hospitals also continue to provide follow-up services and treatment during the pandemic as part of the continuity of health services. In the surveillance, distribution of staff, data collection, and reporting systems components have been implemented, but the assignment of epidemiological experts and inpatient testing have not been implemented. Then the hospital has also implemented a communication mechanism and provided directions regarding COVID-19 to staff. The hospital has also updated logistics equipment and improved equipment but coordination with the hospital network, additional agreements and plans, logistics quality assessment has not been implemented. For laboratory services, the hospital has not implemented COVID-19 testing. For essential support services, the hospital has only carried out additional supply measurements in anticipation of COVID-19. So that it is stated that only 1 in 8 hospitals is ready to face the COVID-19 pandemic while other hospitals are not ready and do not even have a laboratory for diagnosis and treatment for COVID-19 and there is no case management. From the surveyed hospitals, it was also found that there were differences in the supply of personal protective equipment, gloves, masks, and hand sanitizers ⁽¹⁶⁾. Diagnosis is needed because it is a step to prevent the spread of infection and can control cases more quickly ⁽²³⁾. Meanwhile, WHO emphasized that personal protective equipment is indispensable in controlling the pandemic ⁽²⁴⁾.

Other studies also show the unpreparedness of hospitals in the face of a pandemic. It is known that of the 20 hospitals surveyed, only three hospitals have readiness. There are gaps in human resources, equipment, infrastructure, processes, and procedures in hospitals. Approximately 70 % of hospitals have a disaster management committee and 80% of hospitals eliminate non-essential services. In preventing the spread of infection, only 50% of hospitals have standardization certificates and only 40% have personal protective equipment. In case of management, only 45% already have triage at the hospital entrance and 55% of hospitals have provided beds to receive COVID-19 patients. In occupational health, only 25% accommodate staff infected with COVID-19 and 10% provide insurance for staff who treat COVID-19 patients. 70% of hospitals continue to provide health services but only 40% of hospitals have an epidemiologist to implement surveillance. 70.6% of hospitals have held discussions and communications regarding the management of COVID-19. 40% of hospitals also update equipment and supplies inventory. Then in laboratory services, only 40% were able to identify confirmed cases of COVID-19. And many hospitals reportedly do not have adequate supplies related to COVID- 19 treatment ⁽¹⁷⁾.

Hospital readiness, especially the ICU in the hospital, was 54% although adult ICUs were found to be more prepared than pediatric ICUs and recommended training for staff and active communication ⁽²⁰⁾. Staff training is needed to ensure readiness and skills to handle COVID-19 cases ⁽²⁵⁾. It was reported that coordination was 80%, inventory and logistics management 75%, information management 28%, communication management 43%, human resources 28%, primary health care implementation 60%, identification 61%, diagnosis 61%, case management 47%, control and prevention of infection 68% ⁽²⁰⁾.

Then there are also hospitals that more than 50% of hospitals have the ability to identify and manage patients also access to visit the hospital, although for communication it is only 1.2% which is still categorized as low. For planning and decision-making, the score was 41.2%, COVID-19 development planning was 45.1%, general 45.1%, availability of medical supplies 37.3%, occupational health 51%, training 27.5%, health services 39.2%. Only 43% of hospitals are prepared to deal with a pandemic. There is also no relationship between readiness and resilience ⁽¹⁸⁾.

The absence of developing a plan to respond to COVID-19 has also caused delays in hospital readiness in dealing with the COVID-19 pandemic. Only about 50% of hospitals are reported to be ready to handle the pandemic. Only 34.6% of hospitals accept COVID-19 patients and 65.4% have a COVID-19 management committee ⁽²¹⁾.

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In a study conducted in Idaho, hospitals have a basic structure for prevention and management to deal with COVID-19 cases. All hospitals implement an infection control program, structural incident reporting, and has occupational health and safety. 88% of hospitals can identify cases of COVID-19. On average, hospitals have 83.2% of personal protective equipment, 84% of hospitals have banned patient visits to minimize transmission, more than 90% of hospitals have preventive measures before receiving suspected cases of COVID-19, 88% have rooms dedicated to patients and suspected cases of COVID-19 ⁽²²⁾.

In another study, it showed that management staff in the COVID-19 department got a percentage of 40%

good and 40% very good. In logistics and supplies, supplies of personal protective equipment were 31.4%

adequate, 42.9% good, and 17.1 very good. For the management and diagnosis of COVID-19, the ability to schedule and receive COVID-19 patients who access from other health facilities is 40% good and 56.7% and the COVID-19 reporting process to health authorities is 40.7% good and 51, 9% is very good. Then on communication, communication with health authorities to make hospital planning is 44% good ⁽¹⁹⁾.

The hospital also reported that since the first emergency response to the COVID-19 pandemic, strong support and coordination from the government was key. Where to work together to make plans and then implement them in response to the pandemic. This approach efficiently prepares steps for service requests and ensures that actions are taken as needed. The government and community need to colabrate and support each other to overcome COVID-19 pandemic.

CONCLUSION

From articles that are obtained from various countries regarding hospital readiness in dealing with the COVID-19 pandemic, it is concluded that hospital readiness in dealing with the COVID-19 pandemic is highly necessary to overcome infection transmission, but in fact there are still hospitals that are still not ready. Evaluation and support from the community and government are needed as well as improving the health system to increase hospital readiness in dealing with the pandemic.

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