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.