Expanding Hospitals During Disasters: A Scoping Review of Temporary Annex Facilities in Hospitals During the COVID-19 Pandemic

Introduction: Space is a crucial hospital resource that is often overwhelmed by patient surges during disasters. Temporary hospital annexes were key infrastructural expansions forced by the COVID-19 pandemic. This scoping review explored construction, workflow features of, and experience setting up annex facilities. Methods: Pubmed, Embase, and CINAHL databases, as well as gray literature, were searched for articles or reports of annexes, shelters, or related structures built or adapted within hospitals for clinical use during the pandemic. Reference lists and citations from included manuscripts were manually searched. Design, physical properties, construction process, workflow, and clinical utilization were extracted using a predefined form and thematically analyzed. Results: 470 articles were screened, and 9 relevant articles were identified. Broad strategies for temporary annex facilities were (1) repurposing non-clinical areas and (2) building de novo structures. Non-clinical areas repurposed were a conference room and a multi-storey car park. De novo structures built were tents, containers, or both in combination. The annexes were often located adjacent to the emergency department (ED) (6, 66.7%), where the surge was greatest, and used for triage, swabbing, and low-acuity management before discharge. Car parks (2, 22.2%) were chosen for their segregation from clinical buildings while still being accessible for diverting stable patients from the ED and referring providers. Most annexes used for low-acuity ED diversion were converted or built in three to six days. One de novo container, a 50-bed isolation ward, required 50 days. Two reports used de novo containers and tents for Computed Tomography and plain radiography, respectively. Reports describe reduced ED length of stay, wait times for investigations, and Personal Protective Equipment usage. Conclusion: This scoping review identified strategies to increase hospital infrastructure capacity and matched relevant construction and workflow features to function during the COVID-19 pandemic. Hospital stakeholders can contextualize these experiences to improve infrastructure preparedness to disasters.