# Patient coordination during the COVID-19 pandemic in the Amsterdam region: effects on capacity utilization and patient flow

## TL;DR

This study shows that coordinating patient distribution during the pandemic helped balance hospital capacity and improve patient flow in the Amsterdam region.

## Contribution

The study demonstrates the effectiveness of centralized patient coordination in managing hospital capacity during a health crisis.

## Key findings

- Centralized coordination reduced hospital utilization above 100% in some hospitals during the first cohort.
- Coordination improved utilization in most hospitals that were underutilized without coordination.
- Load-balancing through coordination led to better distribution of patient care demand.

## Abstract

To manage COVID-19 surge demand, Dutch regional and national task forces were installed to coordinate a proportionate patient distribution. This study examined the effect of centralized COVID-19 patient coordination on hospital capacity utilization during the pandemic.

A retrospective observational double cohort study compared intra- and interregional patient coordination by the regional task force ROAZ Noord-Holland Flevoland. Coordination was compared to a simulated scenario without coordination based on a queueing model during two time periods from January 1, 2021, until May 1, 2021 and from August 1, 2021, until December 1, 2021. Daily data on patient ICU and clinical COVID-19 patient transfers, number of admissions, and capacity were assessed. The primary outcome was hospital capacity utilization.

Overall, 1,213 patients were transferred both within the eleven regional hospitals and outside the region during cohort I and 528 patients during cohort II. During the first cohort, eight hospitals (ICU patients) and two hospitals (clinical patients) showed a utilization factor exceeding 100% without coordination which reduced to below 100% with coordination. During the second cohort, utilization factors exceeding 100% varied between the scenarios with and without coordination. In both cohorts, the majority of hospitals that showed a utilization factor below 100% in the scenario without coordination, showed an increased utilization factor in the scenario with coordination.

This retrospective double cohort analysis based on regional coordination of COVID-19 patients and a simulated scenario of absent regional coordination, identified that load-balancing of COVID-19 care demand generally resulted in an improved distribution of utilization among hospitals. In a crisis, we suggest a swift upscale from local, regional to national centralized coordination activity to enable inter and intra-regional patient coordination at an early stage. Future research is recommended to explore the applicability of coordination for other patient categories to benefit from regional centralization during a crises.