In a report released by the U.S. Department of Health and Human Services (HHS), hospitals reported the most significant challenges they are facing during the COVID-19 pandemic.
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Survey Methods
Brief telephone interviews were conducted from March 23 to March 27, 2020, with one or more administrators from 323 hospitals in 46 states, the District of Columbia, and Puerto Rico. Hospitals included in the survey represented a wide range of sizes and characteristics and included special pathogen centers, major teaching hospitals, and critical access hospitals.
Most hospitals included in the survey were treating patients with either suspected or confirmed COVID-19 infection. The administrators surveyed were typically either a Chief Executive Officer, Chief Medical Officer, or a representative from teams or departments within the hospital focused on emergency preparedness or incident command. Most hospitals included in the survey had 101 to 500 beds (n = 131).
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?
Responses
Hospitals replying to the survey reported that testing and caring for patients with confirmed or suspected infection and keeping their staff safe were their most significant challenges.
Severe shortages of testing supplies and long waits for test results (frequently 7 days or longer) made it difficult to monitor patient and staff health. Hospitals reported lacking testing kits altogether, or lacking components of testing kits. Also, the long waits for results contributed to longer patient stays in the hospital.
Hospitals also touched on shortages and/or lack of personal protective equipment (PPE) for their staff. Due to the pandemic, many hospital staff are using PPE at an increased rate, and along with issues with the supply chain, this was depleting hospital reserves of PPE. Respondents also noted that sources of PPE were now uncertain, and that the price of PPE from some vendors was increasing.
Other issues that hospitals mentioned experiencing during the pandemic included:
- Difficulty in maintaining adequate staff, both specialized providers and support staff
- Maintaining and expanding institutional capacity
- Shortages of materials other than PPE, including items that support a patient room, thermometers, disinfectants, and cleaning supplies
- Anticipated ventilator shortages
- Higher costs and decreased revenue.
Respondents also mentioned that unclear guidance from federal, state, and local authorities was confusing to both health-care staff and the public. Conflicts in guidance on testing, elective procedure deferral, PPE usage, and supply from the national stockpile were noted. Public misinformation was also cited as a challenge for hospitals, increasing their workload as patients are coming to hospitals unnecessarily and relying on hospitals for education.
Assistance Needed
Hospitals surveyed also noted areas of assistance that HHS and other federal or state agencies may be able to give.
- Testing, supplies, and equipment. Hospitals thought government intervention in competition between providers may help ensure fair allocation. Also, hospitals noted that the government should ensure they have access to testing kits and swabs; make testing faster by allowing more entities to produce and run tests; and assist in the procurement of ventilators and PPE.
- Workforce allocation. Hospitals asked that reassignment of licensed professionals and realignment of duties be allowed, along with allowing staff to work across state lines.
- Capacity of facilities. Hospitals requested relaxed rules concerning bed designations and surge facilities in nontraditional settings, and expanded flexibility for what may be eligible for reimbursement.
- Financial assistance. All kinds of institutions requested financial assistance, ranging from faster and larger Medicare payments to loans and grants.
- Communication and information. Hospitals noted the need for centralized, consistent communication and public information. They also mentioned the need for a central repository for all COVID-19–related guidance, data, and information.
The report concluded, “This report provides information about hospitals’ experiences and perspectives in responding to COVID-19 at a point in time—March 23–27, 2020. The pandemic is fast-moving, as are the efforts to address it. Since our interviews, some hospital challenges may have worsened and others may have improved. Hospitals reported that their most significant challenges centered on testing and caring for patients with known or suspected COVID-19 and keeping staff safe. Hospitals also reported substantial challenges maintaining or expanding their facilities’ capacity to treat patients with COVID-19."
“We recognize that HHS, Congress, and other federal, state, local, and tribal entities are taking substantial action on a continual basis to support hospitals as they work on the frontlines to treat patients, ensure the safety of the health-care workforce, and protect communities. We present this information for HHS’s and other decision-makers’ consideration as they continue to respond to the COVID-19 pandemic. In addition, hospitals may find the practical information about other hospitals’ strategies useful as they confront the many challenges they face in fulfilling their mission.”
