The Forum

The 3 types of Covid-19 field hospitals (and what they mean for your organisation)

by Rachel Longhurst and Rachel Zuckerman

When Wuhan's 1,000-bed Huoshenshan Hospital opened its doors in February, the world watched in awe as the facility, built in under 14 days, started immediately caring for Covid-19 patients. That effort gave life to other building projects around the world—with some health systems and government establishing even larger facilities.

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While these facilities are all referred to as 'field', 'makeshift', or 'pop-up' hospitals, they target different segments of the population and have distinct impacts on health care ecosystems. We took a look at Covid-19 field hospitals around the world to better understand which model is prevailing and what questions health care leaders need to ask now to assess the impact of local field hospitals.  

What types of Covid-19 field hospitals are there?

Below, we provide an overview of the advantages and disadvantages of the three major categories of field hospitals—and the field hospital strategy we see "winning out" around the world.

1. Quarantining mild to moderate cases of Covid-19

China used makeshift hospitals, including Huoshenshan Hospital in Wuhan, to isolate all mild to moderate cases of Covid-19. This approach helped separate Covid-19 positive patients from family members. The hospitals also used frequent monitoring and rapid referral protocols to transfer patients to existing hospitals if their conditions worsened.

Despite these benefits, using field hospitals to isolate all mild to moderate patients isn't helpful to many other countries, given that most of the Western world is opting for a social distancing and home quarantine approach.

2. ICU capacity to care for critically ill Covid-19 patients

The ability to quickly create additional critical care capacity has been crucial in certain areas, particularly in the earliest and hardest hit areas that had little time to prepare and quickly saw (or anticipated) outstripped ICU capacity. For example, the Fiera Hospital in Milan, Italy, and the military field hospital in Mulhouse, France proved invaluable for ensuring patients got the care they needed.

However, clinicians have spoken out about the risks associated with transferring critical care patients, as well as treating extremely sick patients in temporary facilities with limited equipment. Health care leaders have also expressed concern that ICU staff and supplies are already in high demand and short supply, which may leave temporary hospitals competing with existing hospitals for limited resources.

Further, it seems that many areas won't need this additional ICU capacity. For example, existing hospitals in London seem to be holding out with the additional ICU capacity they've managed to create internally, leaving the NHS Nightingale Hospital London largely empty.

3. Step-down units for recovering Covid-19 patients

These facilities are intended for patients recovering from Covid-19 who no longer need to be in a critical care environment but can't yet return home. These facilities, which include Dragon's Heart Hospital in Cardiff, Wales and NHS Nightingale Hospital North West in Manchester, England, are more flexible than hospitals equipped to provide critical care, and they avoid some of the main challenges associated with ICU field hospitals (e.g., high-risk transfers, greater staff needs). Crucially, they help address discharge bottlenecks, freeing up space in existing hospitals.

This is the type of field hospital we see 'winning out' around the world, particularly for areas that have had more time to prepare by increasing existing hospital capacity, flattening the curve, and learning more about how to care for the disease.

How can you assess the impact of your local field hospital?

While each hospital will have a unique relationship to local makeshift facilities, every hospital leader assessing the impact of a local field hospital should ask these three questions.

1. What types of patients can we send to the field hospital?

Centralised communication is key to ensure hospitals know how to use the field hospital. If the answer is unclear, continue to seek clarity from the government or authority running the field hospital, and hardwire this criteria into clinical decisions at your organisation.

2. How will the field hospital impact staffing at our organisation?

Staffing has been a key challenge for many. In London, for example, clinicians have expressed concern that the Nightingale Hospital will put a strain on already stretched staffing levels across the capital. Maintain strong communication with leaders at the temporary site, offer alternative staffing ideas (for example, many field hospitals are tapping into military medics), and ensure your hospital staff have clear guidelines on how to approach volunteering at temporary sites.

3. What additional capacity do we anticipate needing in 2-4 weeks?

Since field hospitals typically take a couple weeks to build, leaders should proactively advocate for the type of capacity you expect to need several weeks out. For example, do you anticipate needing recovery beds, critical care capacity, or space for non-Covid-19 patients?

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