How do you transform a hotel into a hospital for COVID patients?

An interview with Dr David Nicolás and nurse Núria Seijas, medical coordinator and nursing care coordinator at the Home Hospitalisation Unit.

Nurse Núria Seijas and Dr. David Nicolás

For Dr Nicolás and nurse Núria Seijas, who work at Hospital Clínic's Home Hospitalisation Unit, seeing patients outside the hospital environment was nothing new. However, the urgent need for space as COVID-19 infections peaked meant they had to adapt. The result? Setting up a hotel for patient care. They tell us all about it in this interview.

At what point in the pandemic did the need for the Health Hotel arise?

- NS: It arose out of the need to prevent a collapse of hospital services, which was at the point of happening at the time. Everything was done very quickly. Beds were needed and it was decided that this was a good place for the patients. It had to be external, because the hospital couldn’t take any more.

- DN: It was at a point of exponential growth in infection numbers, with more and more people being admitted every day. On the morning of 25th March, we decided to set up a place outside the hospital to accommodate patients.

Are these kinds of ‘extreme’ measures planned, or did they emerge spontaneously out of necessity?

- DN: It wasn’t planned. Several hotel groups offered to help the Health Department and the hospital. A team went to assess several options. It was decided that the Plaza Hotel met the location requirements and other necessary conditions.

Nuria Seijas ‘Such a low readmission rate shows that the patients admitted to the hotel were very well selected’.

What were the main challenges involved in adapting a hotel to accommodate treatment of COVID patients?

- DN: Our work is always based on the principle of safety, for patients and employees alike. We were moving hundreds of hospital workers, who had no previous experience in infectious contagious diseases, into a completely atypical setting. The main challenges were related to this, ensuring everyone worked as safely as possible.

More than 500 patients were admitted to the Health Hotel. Did they progress well?

- DN: They actually did very well. The hospital readmission rate was just 5% of patients, about 20 people. This is a very, very low rate.

- NS: Patient selection is very important. Such a low readmission rate shows that the patients were very well selected. The patients who were there were those who needed to be, and they recovered well.

What kind of patients were candidates for transfer to the hotel? Was this type of admission suitable for any patient?

- DN: There were two types of patients who could be admitted to the Hotel. On the one hand, there were those who were recovering from a severe case of COVID, who were improving, but were not yet ready to be sent home. And the other type was patients who came to A&E with bilateral pneumonia and no risk factors, or with risk factors but no bilateral pneumonia. In other words, patients with incipient COVID disease but who, based on the knowledge we had, were expected to progress favourably.

- NS: One of the limitations when it came to selection was that we could not choose highly dependent patients, because the infrastructure of the hotel meant they could not receive adequate care. There were hotel beds, hotel showers... Bedbound patients couldn’t be treated there.

Nuria Seijas ‘Working with professionals from all specialities was a challenge, but at the same time a pleasure, as everyone offered a different perspective.’

As professionals, what was your role before COVID, and how did it change afterwards?

- NS: I was the nursing care coordinator for Home Hospitalisation, and then I was the nursing care coordinator at the Health Hotel. Between nursing staff, nursing technicians, auxiliaries and healthcare assistants, I managed more than 120 people. This included professionals from all of the Hospital’s departments.

It was a challenge and a pleasure because each person offered a different perspective according to their area of specialism. There were laboratory and operating theatre professionals, as well as early retired professionals who were reinstated, and also students. The truth is that it was very difficult to get all the staff, but in the end a fantastic team was formed. And thanks to our shared objective, we were all working in the same direction.

And what about you, Dr Nicolás?

I am a home hospitalisation doctor, and when the hotel was set up, I had the role of Medical Care Coordinator. I coordinated the medical professionals who worked there, some 80 people, including doctors from other departments and doctors who had just passed their exam to become resident medical interns. I coordinated the teams, the clinical part, and the admission criteria for patients.

David Nicolás ‘The thought that there could be a COVID outbreak among professionals at the Health Hotel kept me up at night’.

All the professionals had to adapt and learn to work in a very different way in record time. Was it complicated?

- NS: Honestly, it was complicated. At the start, all professionals were given training in putting on and taking off their PPE. It's certain that the measures worked well. Out of all the professionals working there, very few were infected.

- DN: The supervision work was very important. We were always watching people to see how they put on and removed their PPE. There was continuous training on protective measures. It was something that kept me up at night, the thought that there might be an outbreak, that we might all get infected. This was very present in our minds at all times.

- NS: The work our colleagues did in terms of infrastructure, maintenance and information systems should also be highlighted. I believe this made all the difference in allowing us to work as safely as possible.

- DN: It allowed us to connect to Hospital Clínic’s secure network, just as we do here. It was an essential and very intense job, as everything was put together in 4 days.

- NS: A telephone network was even set up to imitate the function of hospital buzzers, so patients could let us know if something happened to them.

You both work in home hospitalisation. Can you explain what this is? What benefits does it offer?

- NS: Home hospitalisation means that a patient who meets hospital admission criteria, who would normally be admitted to hospital, receives care at home instead. This offers many benefits: the patient is in their own environment, the risk of nosocomial (hospital) infections is reduced, faster recovery, having their family there, etc.

- DN: We are a cross-disciplinary unit that works with all the hospital’s departments. We care for all types of patients, those admitted for both medical and surgical reasons.

David Nicolás ‘COVID-19 made us realise the importance of flexibility and the ability to adapt’.

Is it safe to send patients home so soon? Don’t they need more monitoring?

- DN: It’s not a case of sending the patient home and that’s it. The idea is to substitute the care patients receive in hospital with the same level of care at home. These patients are very carefully selected. We choose them based on who requires more or less care. Furthermore, our readmission rate is very low, around 5%, which indicates that the patients are well selected.

- NS: The patient receives a visit from a nurse every day, and they also have regular medical visits. There is also a telephone number where we can be contacted directly, 24 hours a day. Patients receive a call 30 days after discharge requesting that they complete a satisfaction survey. The degree of satisfaction we get is very high, at 98%. At first they are afraid, but then some patients who have had to repeat the experience due to acute chronic pathologies ask us whether they will be able to return to home hospitalisation from the start. We also ask caregivers about their level of satisfaction, and the figures are always around 95%.

What do you think you learned from the whole pandemic situation, setting up the Health Hotel, changing your way of working, etc.?

- DN: I think the main lesson COVID taught us is the importance of flexibility and adaptability. When we were put in charge of adapting the Health Hotel, we were already thinking about this, about the capacity we have as a home hospitalisation unit to work and adapt to places outside the hospital environment. Perhaps now we have realised the importance of adaptation, and I think that is something we have to continue with: adapting to change, to crisis situations and also to moments of peace.

- NS: I would highlight teamwork. I think this is one of the things that should be highlighted about the Health Hotel. It worked because we all formed a team.