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Background: Hospital adaptation and resiliency, required during public health emergencies to optimize outcomes, are understudied especially in resource-limited settings., Research Question: What are the prepandemic and pandemic critical illness outcomes in a resource-limited setting and in the context of capacity strain?, Study Design and Methods: We performed a retrospective cohort study among patients admitted to ICUs at two public hospitals in the KwaZulu-Natal Department of Health in South Africa preceding and during the COVID-19 pandemic (2017-2022). We used multivariate logistic regression to analyze the association between three patient cohorts (prepandemic non-COVID-19, pandemic non-COVID-19, and pandemic COVID-19) and ICU capacity strain and the primary outcome of ICU mortality., Results: Three thousand two hundred twenty-one patients were admitted to the ICU during the prepandemic period and 2,539 patients were admitted to the ICU during the pandemic period (n = 375 [14.8%] with COVID-19 and n = 2,164 [85.2%] without COVID-19). The prepandemic and pandemic non-COVID-19 cohorts were similar. Compared with the non-COVID-19 cohorts, the pandemic COVID-19 cohort showed older age, higher rates of chronic cardiovascular disease and diabetes, less extrapulmonary organ dysfunction, and longer ICU length of stay. Compared with the prepandemic non-COVID-19 cohort, the pandemic non-COVID-19 cohort showed similar odds of ICU mortality (OR, 1.06; 95% CI, 0.90-1.25; P = .50) whereas the pandemic COVID-19 cohort showed significantly increased odds of ICU mortality (OR, 3.91; 95% CI, 3.03-5.05 P < .0005). ICU occupancy was not associated with ICU mortality in either the COVID-19 cohort (OR, 1.05 per 10% change in ICU occupancy; 95% CI, 0.96-1.14; P = .27) or the pooled non-COVID-19 cohort (OR, 1.01 per 10% change in ICU occupancy; 95% CI, 0.98-1.03; P = .52)., Interpretation: Patients admitted to the ICU before and during the pandemic without COVID-19 were broadly similar in clinical characteristics and outcomes, suggesting critical care resiliency, whereas patients admitted to the ICU with COVID-19 showed important clinical differences and significantly higher mortality.

Indonesia is a country prone to experiencing natural hazards and disasters, which have frequently damaged public infrastructure, including hospitals. The role of hospitals is crucial to alleviate the impact of disasters. However, there is still a lack of study that analyzes the factors that influence the readiness of hospitals in emergency situations. Filling in this gap, the aim of this paper is to analyze and rank hospitals across West Java and Yogyakarta, Indonesia by the resilience of their emergency management approaches. This research seeks to measure hospital resiliency during emergencies and disasters. Results indicate that the emergency and disaster management coordination, response and disaster recovery planning, communication and information management, logistics and evacuation, human resources, finance, patient care and support services, decontamination and security are key attributes for the decision-making matrix. Based on the Hospital Safety Index tool, this research proposes the Hospital Emergency and Disaster Management (HEDM) index by combining the key attributes and sub-attributes using the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) as a multi-attribute decision-making technique. The paper concludes that the anticipated benefits of analyzing the resilience of hospitals by using HEDM is the identification of the most susceptible hospitals based on their levels of readiness and resiliency in areas which are prone to experiencing disasters. This prioritization is important for resource allocation and budget planning. [ABSTRACT FROM AUTHOR]