Table 1.

Challenges encountered by the hospital and local solutions found

Challenges	Local solutions
Management of suspected and confirmed patients with COVID-19
Preparedness	-Identifying facilities in the hospital and ensuring technical maintenance -Training frontline healthcare workers on the management of outbreaks -Carrying out practical exercises within the various units (ID, IPC, ICU, ED, microbiological laboratory) -Anticipating the links between pre-hospital care and hospital care -Testing the system during suspected cases of previous emerging infectious diseases (e.g. MERS-CoV, Ebola) -Implementing the technical supervision across units by head nurses who have sufficient experience and are regularly trained
Adapting to a new microorganism	-Setting up scientific and epidemiological bibliographic watch -Local adaptation of national and international protocols -Regular crisis meetings involving healthcare workers, head of departments and administrative staff to ensure a comprehensive and collective strategy -Adapting the strategy in real time to the evolution of the epidemiology and scientific knowledge
Biosafety level 3 (then 2) laboratory examinations	-Having on-site RT-PCR as soon as possible -Regular training of laboratory technicians on biosafety levels 3 and 2 -Developing point-of-care testing at the bedside
Anticipating the increase of cases	-Setting up an outpatient 24/24 circuit in the ID department for possible cases -Planning for a sustained and increased response involving every hospital department -Anticipating the circuits to be implemented in the event of an increase in cases -Securing central storage of medical equipment organized by the IPC and logistics department that secondarily dispatch the equipment in order to avoid stealing and stock-outs (masks, etc.)
Logistical considerations
Moving patients in the hospital for radiological examinations or surgery	-Information and training of the healthcare workers of the second-line departments (radiology technicians, stretcher-bearers, surgical nurses) upstream of the request for transport, examination or surgery -Pre-identified safety circuits for patients -Mobilizing the security team to prevent access during transport -Systematic medical supervision of transport/examinations
Organizing the switchboard	-Protocols for the management of calls -Implementing a national free number not managed by the hospital in accordance with health authorities
Links with the pre-hospital care	-Regular communication between the hospital and ambulance services and the paramedics on the pathway of suspected cases -Protocols and training in the ED
Hazardous waste management	-Anticipating the risk of outbreaks with the provider -Communicating with the provider about the epidemic -Involving hospital management team
Managing and taking care of healthcare workers
Healthcare workers' anxiety	-Press conference to the general public in order to limit the spread of rumours coming from outside - Real-time information of the healthcare workforce and of all the hospital staff -Effective leadership by the heads of department and the hospital management -Regular communication on the local situation (e.g. on the intranet) -Organizing psychological support and team feedback -Systematic surveillance of exposed healthcare workers
Increased need for healthcare workers	-Mobilization within the pool of hospitals (e.g. AP-HP) or at the regional level -Identifying the professions that are the most needed: in our case; nurses, laboratory technicians, switchboard personnel and staff in the intensive care units
Avoiding double standards between healthcare workers who take care of the suspected and confirmed cases and those who do not	-Emphasizing the importance of usual care -Ensuring a rotation of healthcare workers who are involved in SARS-CoV-2 management -Creation of pairs of healthcare workers with an experienced nurse coupled with a nurse in training in order to rapidly increase the number of trained healthcare workers -Regular team meetings to keep proximity
Continuing usual care, research and teaching activities as long as possible
Evaluating and anticipating collateral effects	-Documenting the different aspects of the impact, direct and indirect on the healthcare structure -Setting up a financial envelope to cover the costs of the management of the outbreak
Increasing the availability of beds	-Contacting long-term healthcare facilities to prioritize the patients from hospitals taking care of confirmed cases -Involving local and regional health authorities
Organizing the development of research projects	-Putting in place a ‘crisis cell’ for research purposes -Pre-validation of circuits to deal with research during epidemics (e.g. ISARIC) -Harmonizing clinical research with patient care
Maintaining teaching activities	-Seizing opportunities to teach students and residents about outbreak management -Organizing the training of healthcare workers

ID, infectious diseases department; IPC, infection prevention and control; ICU, intensive care unit; ED, emergency department.