ASSESSING HOSPITAL EMERGENCY PREPAREDNESS
Authors:   Federal Research Institute for Health Organization and Informatics of the Ministry of Health of the Russian Federation, Moscow, Russian Federation, Rugol Ludmila 
Published: January 2024

Significance. The COVID-19 pandemic has led to a crisis in society and seriously challenged healthcare capabilities around the world. The industry's lack of preparedness for such a large-scale and rapid spread of the virus around the world was one of the major factors in the fight against the pandemic faced by medical organizations and health services around the world. During the pandemic, the Russian Federation (hereinafter referred to as the RF) has radically restructured activities of medical organizations, re-equipped them with modern medical equipment, and intensively developed digitalization, making it possible to prevent the collapse of the industry and ultimately successfully cope with the pandemic. Analysis of the results and consequences of the restructuring the entire industry, medical organizations providing medical care of various types and in different conditions, allows us to assess emergency preparedness of hospitals and develop recommendations for the future. The purpose of the study was to assess hospital emergency preparedness in the Russian Federation based on the analysis of dynamics in bed capacity, structure of beds and utilization indicators in 2019-2022. Material and methods: comparative analysis of the number of beds, its structure and utilization indicators in the pre-COVID period, the pandemic period and the early post-COVID period based on the federal statistical observation form No. 30 “Information about medical organization” in the Russian Federation and in the constituent entities of the Russian Federation. Methods included descriptive statistics, comparative analysis and analytics. Results. A long-term trend towards reducing bed capacity and availability of beds was once interrupted in 2020, with the trend towards reducing the number of beds in rural areas remaining interrupted. In general, during the observation period, the total number beds decreased by more than 30 thousand, the population-to-bed ratio decreased by 3%, and the hospitalization rate dropped by 7%. The shortage of adult infectious disease beds at the beginning of the pandemic associated with the prior reduction of bed capacity against the background of the network restructuring was met by repurposing other beds to serve as infectious disease ones, and deploying additional infectious disease beds in and outside medical organizations to treat patients with COVID-19. The number of adult infectious disease beds increased 7.5-fold by the end of 2020. However, the number of adult infectious disease beds then started to decrease reaching a 59,4% increase by 2022 compared to 2019, but their share in rural areas decreased from 14% to 8%. The number of pediatric disease beds increased against the background of competing dynamics. Overall, during the period, the total number of pediatric and adult infectious disease beds increased by 27%. In the structure of adult infectious disease beds, the share of COVID-19 beds varied from 92% in 2020 to 34% in 2022; additionally deployed COVID-19 beds were also in operation. Over the observation period, the average bed length of stay and average bed occupancy decreased, while hospital mortality increased. Significant variability in hospital performance indicators across regions was registered. Conclusion In 2021-2022, hospital facilities in the Russian Federation were prepared to meet the increased incidence of infectious diseases. However, the renewed processes of bed capacity reduction necessitated forecasting sustainability of hospitals in emergency situations. The undertaken analysis shows that a cut in the number of round-the-clock beds should not be guided by the mere process of reduction. The decision to change the bed capacity and structure should be preceded by a thorough preliminary analysis of specialized care availability by each specialty planned to be reduced. Reducing planned hospitalizations and postponing treatment of patients with chronic non-communicable diseases turned out to be not fully justified, which was confirmed by other studies. Infectious disease beds must function in optimal numbers to cope with the increased flow of patients in early stages of an emergency. The areas where infectious disease beds are deployed must be sufficient to realize the possibility of quickly increasing the capacity of an infectious disease hospital to the required level. Planning a network of hospitals should ensure a comprehensive specialized care delivery to patients with chronic non-communicable diseases during emergencies including planned care. Scope of application: Hospital capacity and structure planning.