The COVID-19 Pandemic and the Hospital Surge Preparedness and Response Index: A Retrospective Study in an Italian Hospital

Objective: To quantitatively assess key performance indicator changes between selected pre-pandemic and pandemic periods at the Sant'Anna Hospital emergency department (ED) in Como, Italy through the retrospective use of Hospital Surge Preparedness and Response index (HSPRI).

Methods: This study collected the average length of stay (LOS), time-to-physician initial assessment (TPIA), and left-without-being seen (LWBS) rates for 2 pre-pandemic (control group) and 3 pandemic periods (study group) in the COVID ED (C-ED) dedicated to treat COVID-19 patients and the non-COVID ED (NC-ED) dedicated to non-COVID cases. Quantitative analysis was based on hypothesis testing. A retrospective qualitative theme and subtheme analysis based on the HSPRI was conducted on baseline strategies before each pandemic period and on the actions implemented thereafter.

Results: LOS increased across all pandemic periods. TPIA decreased in the first 2 pandemic periods in comparison to pre-pandemic. LWBS decreased between pre-pandemic and pandemic periods. Of the 22 action items listed in the HSPRI, 8 were implemented in the first pandemic period, 8 in the second and 1 in the third, for a total of 17 items.

Conclusions: The HSPRI demonstrated value as a tool for a hospital staff to actively utilize during a pandemic to identify KPI triggers to formulate actions to maintain pre-pandemic care or ameliorate the deterioration of care during the pandemic.