This review provides the Department of Health and Human Services (HHS) and other decision-makers (e.g., State and local officials and other Federal agencies) with a national snapshot of hospitals’ challenges and needs in responding to the coronavirus 2019 (COVID-19) pandemic. This is not a review of HHS response to the COVID-19 pandemic. We have collected this information as an aid for HHS as it continues to lead efforts to address the public health emergency and support hospitals and other first responders. In addition, hospitals may find the information about each other’s strategies useful in their efforts to mitigate the challenges they are facing.
The hospital input that we describe reflects their experiences and perspectives at a point in time-March 23-27, 2020. The pandemic is fast-moving, as are the efforts to address it. We recognize that HHS, Congress, and other Federal, State, local, and Tribal government entities are taking substantial actions on a continual basis to support hospitals in responding to COVID-19. HHS has already taken and continues to take actions related to each of the challenges that hospitals identified in our survey, and the Coronavirus Aid, Relief, and Economic Security (CARES) Act provides the basis for additional actions. We present this information for HHS and other decision-makers’ consideration as they continue to respond to the COVID-19 pandemic.
This report is based on brief telephone interviews (“pulse surveys”) conducted March 23-27, 2020, with hospital administrators from 323 hospitals across 46 States, the District of Columbia, and Puerto Rico, that were part of our random sample. Our rate of contact was 85 percent.
Interviews focused on three key questions:
- What are your most difficult challenges in responding to COVID-19?
- What strategies is your hospital using to address or mitigate these challenges?
- How could government best support hospitals responding to COVID-19?
Hospitals reported that their most significant challenges centered on testing and caring for patients with COVID-19 and keeping staff safe. Hospitals said that severe shortages of testing supplies and extended waits for test results limited hospitals’ ability to monitor the health of patients and staff. They also reported that widespread shortages of personal protective equipment (PPE) put staff and patients at risk. In addition, hospitals said that they were not always able to maintain adequate staffing levels or to offer staff adequate support.
Hospitals also described substantial challenges maintaining and expanding capacity to care for patients. Capacity concerns emerged as hospitals anticipated being overwhelmed if they experience a surge of patients, who would need specialty beds and isolated areas for effective treatment. Hospitals explained that shortages of critical supplies, materials, and logistic support that accompany more beds affected hospitals’ ability to care for patients. Hospitals also cited anticipated shortages of ventilators as a potential challenge. Hospitals described increasing costs and decreasing revenues as a threat to their financial viability. Further, hospitals reported that changing and sometimes inconsistent guidance from Federal, State, and local authorities posed challenges and confused hospitals and the public.
Hospitals reported using a range of strategies to maintain or expand their capacity to care for patients and to keep staff safe. To secure the necessary PPE, equipment (including ventilators), and supplies for their staff, hospital administrators reported turning to new, sometimes un-vetted, and non-traditional sources of supplies and medical equipment. To ensure adequate staffing to treat patients with COVID-19, hospitals were training medical staff like anesthesiologists, hospitalists, and nursing staff to help care for patients on ventilators. To support staff, some hospitals reported providing services such as childcare, laundry, grocery services, and hotel accommodations that promote separation from elderly family members. To manage patient flow and hospital capacity, some hospitals were providing ambulatory care for patients with less severe symptoms, telehealth services when possible, and setting up alternate facilities such as fairgrounds, and non-operating college dorms and closed correctional facilities as additional space for patient care.
At the time of our interviews (March 23-27, 2020), hospitals reported pressing needs for government assistance to help meet COVID-19 response challenges. Broadly, the actions they described fall into five categories: 1) assistance with testing, supplies, and equipment (e.g., PPE); 2) assistance with workforce allocation; 3) assistance with capacity of facilities; 4) financial assistance; and 5) communication and public information.
We recognize that HHS has taken and continues to take actions toward these hospital challenges and needs. Our report presents hospital suggestions on ways that the government could assist them for HHS’s and other decision-makers’ consideration as they continue to respond to the COVID-19 pandemic.