National COVID-19 patient reallocation scheme
About this good practice
The cloverleaf-concept (cc) is used when intensive care units in certain hospitals in Germany are overloaded and the coordination of distribution of affected patients who are requiring intensive care to other cities or even other states becomes necessary. This should enable all patients to receive a comparably high, comprehensive level of treatment in accordance with current medical standards. Within this concept Germany is divided into five parts, like a five-leaved clover. These parts are: North, East, South, South-West and West. One leaf includes one to five states with strategic and operational maangement stakeholders. Within the leaf one state is nominated as single point of contact (SPoC). SPoCs function as regional coordinating authorities. The SPoC describes the patients to be transferred according to an agreed protocol, which is the basis for the requested SPoC to search for a clinic. The patients can be transferred regionally or nationally. If the states within one leaf still have capacity, the patients are transferred regionally. If the capacities in one leaf are exceeded the patients are transferred nationally. East cloverleaf activated the cc in 12/2020 to transfer the patients regionally. The South and East cloverleaves activated the cc in 11/2021 due to high regional congestion. Since then, strategic transfers over greater distances for capacity balancing took place throughout Germany. In the fourth wave, 34 patients were flown out from Saxony into other states
patient transport costs depend on distance (ground vs. air)
Evidence of success
no regional triage, hospitals/states cooperated, smooth and efficient intensive care patient reallocation, 34 patients were flown out from Saxony into other states
Potential for learning or transfer
Generally, Germany is a country organized in 16 Bundesländer, each with extensive legislative and executive power, provided by national legislation with a framework. Even in such a self-governed system, in times of crisis a more centralized and more organized structure like the cloverleaf with clearly defined hierarchy and overarching decision-making helps save lives. A challenge lies in transforming cloverleaf into a permanent structure, parallel to the Bundesländer.