Bracing for the Wave: a Multi-Institutional Survey Analysis of Inpatient Workforce Adaptations in the First Phase of COVID-19

Abstract

BACKGROUND: Medical centers across the country have had to rapidly adapt clinician staffing strategies to accommodate large influxes of patients with the coronavirus disease 2019 . OBJECTIVE: We sought to understand the adaptations and staffing strategies that US academic medical centers employed in the inpatient setting early in the spread of COVID-19, and to assess whether those changes were sustained during the first phase of the pandemic. DESIGN: Cross-sectional survey assessing organizationlevel, team-level, and clinician-level inpatient workforce adaptations. PARTICIPANTS: Hospital medicine leadership at 27 academic medical centers in the USA. KEY RESULTS: Twenty-seven of 36 centers responded to the survey (75%). Widespread practices included frequent staffing reassessment, organization-level changes such as geographic cohorting and redeployment of nonhospitalists, and exempting high-risk healthcare workers from direct care of patients with COVID-19. Several practices were implemented but discontinued, such as reduction of non-essential services, indicating that they were less sustainable for large centers. CONCLUSION: These findings provide guidance for inpatient leaders seeking to identify sustainable practices for COVID-19 inpatient workforce planning.

A proactive learning approach toward building adaptive capacity during COVID-19: A radiology case study

“…In this study, the RETIPS tool was applied in Radiology-specific settings to allow the hospital to identify what enabled successful adaptation at operational levels during the COVID-19 pandemic. As a self-report method of identifying hospital adaptations during this pandemic, the study is unique in that it was conducted within an organization focusing on frontline workers, whereas previous surveys were multi-institutional and targeting leadership-level respondents ( Auerbach et al, 2020 ; Linker et al, 2021 ; Mitchell et al, 2021 ). We received a high response rate in a short period of time coinciding with rapid transitions at multiple organizational levels.…”

“…Other studies have reported data collected through multi-institutional surveys with clinical and administrative leadership. These surveys largely relied on hospital medical leaders, physicians and researchers for data collection ( Auerbach et al, 2020 ; Linker et al, 2021 ; Mitchell et al, 2021 ). There is a lack of studies reporting perspectives of frontline personnel on operationalizing policies and adaptations in their daily work.…”

The impact of surge adaptations on hospitalist care teams during the COVID-19 pandemic utilizing a rapid qualitative analysis approach

“…A variety of adaptations during COVID-19 have been described in the literature [6,14] and include varying approaches (i.e. lower census versus higher census, geographically based respiratory isolation units versus no geography and many modifications thereof ).…”

Effect of COVID-19 on the implementation of a multifaceted intervention to improve teamwork and quality for hospitalized patients: a qualitative interview study

“…At the start of the pandemic, experts called for the use of quality improvement methods and implementation science in healthcare organizations’ efforts to manage challenges posed by the pandemic [ 1 – 4 ]. Studies describe the rapid adjustments hospitals made to staffing, space, and how services were provided to patients [ 27 , 33 – 35 ], but we know little about how the pandemic affected ongoing quality improvement efforts. Our study helps explain why quality and safety performance appears to have worsened during the pandemic [ 6 , 7 , 36 ].…”