At the end of last year, a new type of coronavirus was discovered in Wuhan, Hubei Province, China, leading to an increase in the number of diseases and deaths worldwide. ¹ The World Health Organization (WHO) “worries that have been declared a global pandemic” are discovered and released by the Ministry of Health every day, and hospital resources and services have been greatly affected by this global pandemic in a short period of time. ^{Reference Lai and Cheong2} Saudi Arabian hospitals and other health facilities play a key role in the national and local responses to the COVID-19 pandemic. ^{Reference Aleanizy and Alqahtani3} The current research proposal focuses on evaluating how these hospitals and facilities work on a global scale. The COVID-19 pandemic experience can recommend procedures and guidelines that can be applied to the management of other emergencies.

When health services and patient needs exceed existing resources, health systems need scalability. Established institutions have developed common definitions for capacity building. For example, the Centers for Disease Control and Prevention (CDC) pointed out that the enhanced potential is “the ability to obtain additional resources when needed in an emergency.” ^{Reference Squitieri and Chung4} Similarly, the Agency for Health Research and Quality defines scalability as the ability of the “health system” to respond to bioterrorism or other major public health emergencies or disasters. ^{Reference Emanuel, Persad and Upshur5}

Continuity of care refers to the quality of care over time. The American Academy of Family Physicians “defines continuity of care” as the process by which patients and doctors cooperate in daily care management to achieve high-quality, affordable care goals. According to this definition, continuity of care refers to the relationship between an individual patient and the doctor over time. Continuity is understood to mean that it goes beyond the interpersonal aspects of nursing, including issues of quality and economic efficiency. This definition is also related to respite care, but the focus here is on the degree of coordination and coherence between different service providers and between different employees. ^{Reference Mauney6} Compared with other quality of care models that usually consider the evaluation of care at a specific point in time, the concept of care continuity adds a longitudinal element. ^{Reference Alyafei and Al Marri7}

As the definition of the American Academy of Family Physicians suggests, continuity of care can include accessibility, effectiveness, and effectiveness issues. Fairness is an important moral value to ensure that all patient groups receive satisfactory continuous care. However, the continuity of care specifically refers to the patient-centered quality aspect described by the Institute of Medicine as: respectful care tailored to the patient’s personal preferences, needs, and values, and based on the values of the patient for all clinical decisions. ^{Reference Milne8,Reference Oldenhof, Postma and Putters9}

However, specifically, emergency response capabilities consist of 3 main components: medical professionals, materials (equipment, medicine, and consumables), and structure (physical structure and management infrastructure, such as incident management systems or incident management systems [IMS]). ^{Reference Barbisch and Koenig10–Reference Solberg, Asplin and Weinick13} When the demand for patient care exceeds existing resources, new COVID-19 pandemic events should focus on improving patient care capabilities. ^{Reference Glantz, Phattharapornjaroen and Carlström14}

By adding these 3 main components of COVID-19 growth (people, materials, and structure), the quality of patient care will also be improved. Additionally, additional staff may be required to take care of the patient individually or in groups; patient care may require additional equipment, such as medical and surgical aids, ventilators, and drugs; additional space may be required to accommodate the patient; and most importantly, a structure needs to be created immediately to effectively adjust resources as needed. This framework, IMS, should use a common and standardized language to connect all systems at the local, regional, state, and government levels. ^{Reference Glantz, Phattharapornjaroen and Carlström14} In the case of COVID-19, external resources may not be available in a timely manner or only to a limited extent. Therefore, local health-related material planners must rely on regional will, mutual support, and effective means of communication and dissemination of information. In the current COVID-19 incident, the communication and transportation infrastructure remain intact, so, if necessary, resources can be easily obtained from external sources. In other cases, all the resources available to you from time to time are local. ¹⁵ In addition to emergency overvoltage, there is a lot of discussion about daily overvoltage, which is a problem with KSA’s chronically overcrowded emergency room (ER). Broadly speaking, both the daily growth and the sudden increase in disasters can be regarded as an imbalance between resources and demand, and the variability of the 2 scenarios seems to have predictable fluctuations. However, between the daily wave and the disaster wave, the differences seem to outweigh the similarities. From the individual’s maximum result to the overall result, this will raise ethical issues. In addition, receiving care that deviates from the standard of daily life can be problematic. It may also become important during the wave of natural disasters. ^{Reference Dugarova and Gülasan16}

The main issues to be addressed in the COVID-19 surge scenario include psychosocial considerations, integration of voluntary services, the need for expertise and tools, the impact of health care providers and victims on mental health, and areas that may require legislation. In situations where demand exceeds resources, an appropriate standard of care is required. Although this article describes the main components of the amplification system, more research is needed to develop repeatable standards and quantify the science of surge. ^{Reference Kaji, Koenig and Bey11}

Hospitals are subject to various regulatory requirements, including internal policies and procedures and external taxes. A lot of attention has been paid to the objective measurement of satisfaction and results, but “scalability” is difficult to define, measure, and quantify. Conceptual definition and specificity make it difficult for hospitals to define how to define and communicate scalability to meet the sudden influx of patient needs. For discussion purposes, hospital scalability is defined as the components required to handle sudden and unexpected increases in the number of patients beyond the current capacity. There is a variety of models that can be used to measure hospital responsiveness. Hospitals should aim to “improve the health system’s ability to respond to public health emergencies.” ^{Reference Kaji, Koenig and Bey11,Reference Dugarova and Gülasan16}

Hospitals’ management generally knows the resources required for each of the above categories to care for a specific number of patients; people recognize that there are some exceptions, mainly related to specific biological threats. Otherwise, one of the problems with emergency response capabilities is determining how many resources the hospital can add to its facilities, and how long it will take to achieve this growth. The number of people seeking help continues to increase. The hospital is currently unable to further improve its response capabilities and medical services. ^{Reference Bravo, Braun and Farias17}

Hospitals can use stored medical supplies and equipment to initially expand patient care capabilities. However, due to many institutions’ implementing timely inventory strategies, on-site resource storage is limited. Although this strategy is cost-effective in daily life, it is problematic. Therefore, the hospital’s ability to maintain scalability depends on the additional services provided by the provider, other hospitals, and, ultimately, government reserves. The speed of this development will depend on the amount of care the hospital is trying to get—as well as what types of mutual assistance agreements exist between institutions, how quickly suppliers can deliver after unplanned requests, and the degree of obligations of suppliers to multiple institutions in the same area (if there is no regional coordination, how many hospitals can use the same source of equipment to release production capacity) and the speed of inventory movement. It is currently not possible to obtain data from the hospital department, the number of additional materials and equipment required for inspection, and the time required to obtain these resources. ^{Reference Honwad18}

One of the most important components of responsiveness is the ability to implement an incident management system when a major impact event occurs. Studies have shown that the obstacle to the response to many incidents is not a lack of resources, but a lack of management systems that adapt resources to current needs. There are few studies on the effectiveness of a well-designed hospital accident management system in the event of natural disasters. ^{Reference Caldera and Wirasinghe19}

Results

Socio-Demographic and Work-Related Characteristics

Female participants comprised 76.6%. Slightly above half of the nursing staff (58.3%) were middle-aged and lying between 30 to less than 40 years old with a mean of 33.24 ± 7.58; 36.7% of nursing staff had more than 10 years of experience with a mean of 9.11 ± 5.47. The majority of nursing staff (84.4%) held a bachelor’s degree in Nursing Sciences. They worked in different working units, including emergency unit (24.0%), endoscopy unit (2.3%), ICU (3.3%), labor and delivery unit (1%), NICU (2.7%), operating room (14%), outpatient (20.7%), PICU (1.3%), medical units (20.6%), and surgical units (10%). The majority of nursing staff (93.3%) practiced nursing during the COVID-19 pandemic, and more than two-thirds of them (60.7%) worked directly with COVID-19 patients (Table1).

Nursing Staff Perception Regarding Hospital Readiness for Continuity of Essential Health Care Services in Line with COVID-19

Table 2 revealed a moderate mean score of nursing staff perception regarding hospital readiness for continuity of health care services (3.89 ± 0.61). The highest mean score was associated with the hospital readiness regarding general principles of continuity of health care services (3.95 ± 0.60) followed by response tasks (3.91 ± 0.68), whereas the hospital readiness regarding recovery tasks of continuity of health care services (3.74 ± 0.68) has the lowest score among these dimensions.

Table 1. Socio-demographic and work-related characteristics of the study subjects (n = 300)

Table 2. Nursing staff perception regarding hospital readiness for continuity of essential health care services in line with COVID-19 (n = 300)

Nursing Staff Perception of Surge Capacity in Health Care in Line with COVID-19

Table 3 shows the average mean value of nursing staff perception regarding surge capacity as 3.83 ± 0.63. The highest mean score was related to the hospital’s ability to manage surge capacity general principles (3.86 ± 0.70), followed by surge capacity basic requirements (3.85 ± 0.67), whereas the lowest mean score was related to the hospital’s ability to manage recovery tasks of surge capacity (3.79 ± 0.75).

Table 3. Nursing staff perception of surge capacity in health care in line with COVID-19 (n = 300)

Correlation and Regression Analysis Between Nursing Staff Perception of Hospital Readiness for Continuity of Essential Services and Surge Capacity in Health Care in Line with COVID- 19

The result illustrated a strong positive significant correlation between nursing staff perception of hospital readiness for continuity of health care services and surge capacity in health care in line with COVID-19 (r = 0.838, P < 0.001). The value of R2 of surge capacity in health care can predict 82.9% of the variance in hospital readiness for continuity of health care services in terms of surge capacity general principles (β = 0.154, P = 0.001, CI: 0.051–0.202), basic requirements (β = 0.457, P < 0.001, CI: 0.316–0.526), and preparedness tasks (β = 0.241, P < 0.001, CI: 0.112–0.346). The results showed a statistically significant impact as signposted by the significant regression model analysis (F = 286.025, P < 0.001) (Tables 4, 5).

Table 4. Correlation matrix between hospital readiness for continuity of essential services and surge capacity in health care in line with COVID-19

* Statistically significant at P ≤ 0.05; r, Pearson coefficient.

Table 5. Regression analysis of hospital readiness for continuity of essential services and surge capacity in health care in line with COVID-19

R = 0.911 R² = 0 .829, adj. R² = 0.827, F = 286.025*, P < 0.001*

F and P, f and P values for the model; R2, coefficient of determination; B, unstandardized coefficients;

Beta, standardized coefficients; t, t-test of significance; CI, confidence interval; LL, lower limit; UL, upper limit.

* Statistically significant at P ≤ 0.05.