On April 6, 2020, with the entire world plunged into the first wave of the coronavirus pandemic, the World Health Organization (WHO) congratulated the Vall d’Hebron Hospital in Barcelona for its management of the health crisis. The agency highlighted the ability of the center to “reformulate all spaces” and “prepare all its professionals to advance the virus.”
Today, the ‘Vall d’Hebron model’ is a case study in schools such as the private business center IESE Bussiness School, which this Monday gave a class to its students entitled ‘Case of the Vall d’Hebron University Hospital: covid management -19 ‘.
The management of the pandemic, according to the manager of Vall d’Hebron, Albert Salazar, was divided into two axes. On the one hand, in the need to work on any project in collaboration with all the agents of the territory . On the other, internally, in the empowerment of multidisciplinary teams. “Covid-19 has shown us that the joint work between specialties, estates, doctors and nurses, is capable of achieving far superior results in patient care,” Salazar said.
“Investigating the management of the pandemic in a hospital like Vall d’Hebron has been a success, since nowadays there is nothing written about it,” said the IESE professor, Jaume Ribera. “[The students] have been able to see a real example of the evolution of the phases of a crisis and how it fits into the future strategy of a hospital center,” he added.
The Vall d’Hebron public hospital, the largest in Catalonia and therefore with more resources than other smaller ones, quickly prepared itself when the first news about the virus arrived from China.
In addition, it managed to six times the beds of intensive care units (ucis) at the peak of the pandemic, hired up to 1,150 more professionals to care for patients and converted the Vall d’Hebron Pavelló d’Esports into a health space to treat the sick with coronavirus. All this earned him the congratulations of the WHO.
Salazar has recognized today that, in the absence of precedents, “there was a very high percentage of improvisation.” “We did not have a model to look at. We knew what was happening in China and Italy, where the situation was catastrophic. We had contingency plans each winter for the flu, but the covid was something else,” Salazar said.
But even so, Vall d’Hebron knew how to anticipate the arrival of the virus: before the first case was detected in Catalonia (on February 22), it created action protocols and contingency plans that raised up to a dozen scenarios.
The management of the center quickly decided that up to 800 administrative workers would work from home, suspended family visits and converted the outpatient visit into a telephone visit. “There was a certain amount of anticipation on our part since the end of January, we did not minimize the threat and we were able to prepare all this,” said the manager.
One of the Vall d’Hebron spaces converted into an ICU and used in the first wave.
Another important element was the “rapid adaptation of spaces” for the most critical patients requiring an ICU. Many of them were getting worse quickly, making it necessary to have available sites. “Before the pandemic we had 52 ICU beds.
In the first wave, we had 222 critical patients in ICU, but we had up to 300 ICU beds prepared [that did not have to be used in their entirety] distributed in 13 different spaces,” he recalled Salazar. All this could be done “because the remaining activity was canceled”, with the exception of emergencies such as stroke, heart attacks and emergency transplants.
“All of Vall d’Hebron practically became a hospital for a single disease. We stayed 50 or 60 beds, one or two days away, from all patients without exception having covid pneumonia,” said the manager of the center. “The most important challenge in the other waves has been to continue treating other pathologies,” he added.
The hospital also installed an assistance center for coronavirus patients in the Pavelló d’Esports de Vall d’Hebron that had a capacity for 132 people. In March, the Barcelona city council gave four sports centers to Vall d’Hebron, Sant Pau, the Clinic and the Sea to set up field hospitals.
Vall d’Hebron also had the Hotel Alimara, 500 meters from the center, to accommodate mildly ill patients who could not quarantine at home.
During the first wave, Vall d’Hebron hired 1,150 new workers, of which the nurses and technicians and orderlies who work with them represented almost 800. According to Salazar, compared to January 2020, the hospital this year has 550 more contracts.
Thanks to this hiring, the manager stressed, “even in the worst moments of the epidemic, the nurses doubled shifts.” “Nor were the patient care ratios altered , that is, we did not reduce the number of nurses, neither in critical nor in semi-critical.”
According to Salazar, the “good organization of shifts and breaks” have made Vall d’Hebron “attractive”. “In summer, when the incidence of covid decreased, we had active contracts so that people could rest. Vacations and breaks were made, and that allowed us to maintain contracts that are now being used.”
The manager explained that the hospital was “on the verge” of not having the adequate personal protective equipment (epis) . “We were a day or a day and a half away, but there was an effort by the whole team to have the epis and respirators ready.”
Experts are not ruling out more pandemics from other viruses in the future at all. Hospitals must be prepared for it. “We are currently carrying out the Vall d’Hebron strategic plan for the next five years and the covid is going to affect this strategy. We must insist on the territorial approach of all projects, have the entire territory, with all the actors, “Salazar asked.
According to him, another key to the success of the hospital in the pandemic has been the “relationship with the territory.” “You have to leave the walls of the hospital and collaborate with nursing homes, with primary care, with other acute care centers.” In addition, Vall d’Hebron has recently inaugurated the Garbí building, in the Parc Sanitari Pere Virgili, destined today for covid patients and which will remain for future pandemics.
At the peak of the first wave, this public hospital was also able to collaborate with others from the private network, such as Chiron and Delphi. In Catalonia, the Ministry of Health put all the beds in private hospitals at the service of the pandemic. “One of the good things about the state of alarm put all the country’s resources in the hands of the public administration,” Salazar stressed.