Variation in Initial U.S. Hospital Responses to the Coronavirus Disease 2019 Pandemic*

Abstract

OBJECTIVES: The coronavirus disease 2019 pandemic has strained many healthcare systems. In response, U.S. hospitals altered their care delivery systems, but there are few data regarding specific structural changes. Understanding these changes is important to guide interpretation of outcomes and inform pandemic preparedness. We sought to characterize emergency responses across hospitals in the United States over time and in the context of local case rates early in the coronavirus disease 2019 pandemic. DESIGN: We surveyed hospitals from a national acute care trials group regarding operational and structural changes made in response to the coronavirus disease 2019 pandemic from January to August 2020. We collected prepandemic characteristics and changes to hospital system, space, staffing, and equipment during the pandemic. We compared the timing of these changes with county-level coronavirus disease 2019 case rates. SETTING AND PARTICIPANTS: U.S. hospitals participating in the Prevention and Early Treatment of Acute Lung Injury Network Coronavirus Disease 2019 Observational study. Site investigators at each hospital collected local data. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Forty-five sites participated (94% response rate). System-level changes (incident command activation and elective procedure cancellation) occurred at nearly all sites, preceding rises in local case rates. The peak inpatient census during the pandemic was greater than the prior hospital bed capacity in 57% of sites with notable regional variation. Nearly half (49%) expanded ward capacity, and 63% expanded ICU capacity, with nearly all bed expansion achieved through repurposing of clinical spaces. Two-thirds of sites adapted staffing to care for patients with coronavirus disease 2019, with 48% implementing tiered staffing models, 49% adding temporary physicians, nurses, or respiratory therapists, and 30% changing the ratios of physicians or nurses to patients. CONCLUSIONS: The coronavirus disease 2019 pandemic prompted widespread system-level changes, but front-line clinical care varied widely according to specific hospital needs and infrastructure. Linking operational changes to care delivery processes is a necessary step to understand the impact of the coronavirus disease 2019 pandemic on patient outcomes.

Impact of COVID-19 on mental health: Effects on screening, care delivery, and people with cystic fibrosis

“…As COVID-19 emerged across the US early in 2020, significant changes were made to healthcare delivery [12] . In CF centers, this included shifting clinic visits from in-person to telehealth and implementing staff redeployments and furloughs.…”

Mass Critical Care Surge Response During COVID-19

“…The TFMCC believes it is an effective operational strategy to reduce documentation requirements to maximize staff time for bedside care during public health emergencies. Clinician documentation should focus mainly on critical care provided and limitations due to resource challenges and should address issues 22,26,[85][86][87][88][89][90] This model assumes all ICU care teams have at least one intensivist or other skilled ICU physician (black circle-and-diamond figures) to surge while maintaining contingency level care. An intensivist or skilled ICU physician may manage up to 12 patients in a 12-h shift when providing only direct hands-on care, and up to 24 patients when combining hands-on care with support and collaboration for up to four other clinician team members (yellow circle-and-diamond figures).…”

“…Figure3-Diagram showing critical care adult physician or provider staffing model for expanding surge coverage 22,26,[85][86][87][88][89][90]. This model assumes all ICU care teams have at least one intensivist or other skilled ICU physician (black circle-and-diamond figures) to surge while maintaining contingency level care.…”

Emergency preparedness: What is the future?

“…In 2017, the CDC published an accompanying checklist to the National Pandemic Preparedness Plan that included hospital-specific actions to guide pandemic planning. 18,19 Although guidance and recommendations informed by previous outbreaks and disasters have been issued for healthcare surge capacity planning and resource allocation for pandemic events, specific recommendations for adequately addressing multiple waves of a continuing pandemic were generally lacking 20 and must be incorporated into future hospital emergency preparedness plans and policies.…”