Background: During the 2009 influenza A (H1N1) pandemic, much attention was focused on healthcare preparedness and surge capacity, yet few data exist on how healthcare systems were challenged by the pandemic and whether preparedness efforts were effective. In the Southern Hemisphere, Argentina reported the largest number of confirmed H1N1-related deaths through August 2009. Most cases were reported from the province of Buenos Aires, where the largest national hospital, a 500-bed multispecialty referral hospital, is located.
Objective: To assess hospital capacity and adequacy of preparedness measures at a large hospital in Buenos Aires, Argentina, during the H1N1 pandemic peak.
Methods: We reviewed daily administrative records for measures of hospital capacity, including number of available hospital beds (overall and critical care), and hospital occupancy by ward from three 3-month periods in 2009 and 2008. We compared data from the 3-month peak pandemic period (June 1-August 31, 2009) both with the previous 3-month period (March 1-May 31, 2009), and with the same 3-month period in 2008 (June 1-August 31, 2008), when seasonal influenza transmission normally peaks in the Southern Hemisphere. Overflow was calculated as bed-days when demand exceeded available resource limits.
Results: Beginning on April 26, 2009, in response to reports of severe influenza in North America, the hospital implemented a pandemic plan, and added a total of 40 beds and 33 ventilators over several weeks (Figure). During the peak pandemic period, the overall number of occupied beds decreased, but critical care demand increased by 16-27% compared with 2008 and 2009 baselines (3837 critical care bed-days, compared with baselines of 3306 and 3033 critical care bed-days). The increase was more marked in adult critical care wards, where ventilated patients increased by 56% compared to 2009 baseline (2220 bed-days, compared with 1427 bed-days). The increase was smaller in pediatric critical care wards, where ventilated patients increased by only 1% compared to 2009 baseline (1617 bed-days, compared with 1606 bed-days). Though hospital capacity was never exceeded during the pandemic, overflow would have occurred for 166 bed-days in adult critical care wards and 3 bed-days in pediatric critical care wards without pandemic planning.
Conclusions: During the period of peak pandemic H1N1 transmission in Buenos Aires, this large hospital experienced fewer overall hospital admissions, but more critical care admissions, especially of adults. Without advanced assessment of total bed and critical care (e.g. ventilator) needs, combined with methods to either redistribute or acquire new resources in a timely fashion, hospital admissions for severe respiratory disease can exceed capacity for a prolonged period during a pandemic.