Feedback on Medical Crisis Direction at Assistance publique‒Hôpitaux de Paris during the COVID-19 Crisis

Abstract

Feedback on the medical crisis management during the first phase of the COVID-19 epidemic was provided to the Assistance publique-Hôpitaux de Paris (AP–HP), the largest university hospital center in Europe. The AP–HP has one AP–HP medical crisis director (DMC), 6 hospital group (HG) DMCs, and one DMC for each of the 39 hospital sites. Management was based on daily AP–HP and GH crisis meetings, disciplinary working groups and reliable daily dashboards, which enabled the optimization of actions. Innovative actions have been implemented: regulation units for intensive care unit entries and exits, follow-up of infected patients at home, contact tracing, and inter-regional transfers of critically-ill patients. The key elements of success were the relationship between General management, DMC, the articulation between the central level and those of the GH, the mobilization of all the actors towards a unique identified objective, and the mobilization of all the caregivers, including students. Among the highlighted avenues for improvement, it is worth mentioning the generalization of DMCs outside the AP–HP in accordance with the regulations, the development of knowledge of the crisis operating mode, the anticipation of training in crisis management, the provision of daily information to all those involved in actions carried out in a long-term crisis, and the participation of care-user representatives. The management of research in times of crisis remains to be invented at the national or even European level.