Observational study of organisational responses of 17 US hospitals over the first year of the COVID-19 pandemic
Lauren Southerland,
Amy Wilson,
Esther K Choo,
Aditya Mahadevan,
Matthew Strehlow,
Christian Schulz,
Danielle M McCarthy,
Evrim Oral,
Marina Del Rios,
Stephen Lim,
Madhav KC,
Srihari V Chari,
Ruth Pobee,
Andrew Nugent,
Christian Hext,
Sarah Newhall,
Diana Ko,
Joshua J Baugh,
David Callaway,
Mucio Kit Delgado,
Zoe Glick,
Christian J Graulty,
Nicholas Hall,
Abdusebur Jemal,
Milap Mehta,
Andrew C Meltzer,
Dar'ya Pozhidayeva,
Daniel Resnick-Ault,
Sam Shen,
Daniel Du Pont
Affiliations
Lauren Southerland
Department of Emergency Medicine, Ohio State University, Columbus, Ohio, USA
Amy Wilson
Oregon Clinical and Translational Research Institute (OCTRI), Oregon Health & Science University, Portland, Oregon, USA
Esther K Choo
Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
Aditya Mahadevan
Department of Emergency Medicine, Stanford University, Stanford, California, USA
Matthew Strehlow
Department of Emergency Medicine, Stanford University, Stanford, California, USA
Christian Schulz
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
Danielle M McCarthy
Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
Evrim Oral
Department of Biostatistics, School of Public Health LSU Health Sciences Center, New Orleans, Louisiana, USA
Marina Del Rios
Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
Stephen Lim
Section of Emergency Medicine, Department of Medicine, University Medical Center New Orleans, LSU Health Sciences Center New Orleans, New Orleans, Louisiana, USA
Madhav KC
Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center (COPPER) Center, Yale School of Medicine, New Haven, Connecticut, USA
Srihari V Chari
Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
Ruth Pobee
Department of Emergency Medicine, University of Illinois Chicago, Chicago, Illinois, USA
Andrew Nugent
Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
Christian Hext
Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin, USA
Sarah Newhall
Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
Diana Ko
Department of Radiology, Stanford University, Palo Alto, California, USA
Joshua J Baugh
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
David Callaway
Department of Emergency Medicine, Atrium Health, Charlotte, North Carolina, USA
Mucio Kit Delgado
Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Zoe Glick
Department of Emergency Medicine, University of Maryland, Baltimore, Maryland, USA
Christian J Graulty
Department of Emergency Medicine, NYU Langone School of Medicine, New York, New York, USA
Nicholas Hall
Department of Emergency Medicine, Stanford University, Stanford, California, USA
Abdusebur Jemal
Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
Milap Mehta
Department of Emergency Medicine, Ohio State University, Columbus, Ohio, USA
Andrew C Meltzer
Department of Emergency Medicine, George Washington University School of Medicine, Washington, DC, USA
Dar'ya Pozhidayeva
Oregon Clinical and Translational Research Institute (OCTRI), Oregon Health & Science University, Portland, Oregon, USA
Daniel Resnick-Ault
Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
Sam Shen
Department of Emergency Medicine Medicine, Stanford University, Palo Alto, California, USA
Daniel Du Pont
Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Objectives The COVID-19 pandemic has required significant modifications of hospital care. The objective of this study was to examine the operational approaches taken by US hospitals over time in response to the COVID-19 pandemic.Design, setting and participants This was a prospective observational study of 17 geographically diverse US hospitals from February 2020 to February 2021.Outcomes and analysis We identified 42 potential pandemic-related strategies and obtained week-to-week data about their use. We calculated descriptive statistics for use of each strategy and plotted percent uptake and weeks used. We assessed the relationship between strategy use and hospital type, geographic region and phase of the pandemic using generalised estimating equations (GEEs), adjusting for weekly county case counts.Results We found heterogeneity in strategy uptake over time, some of which was associated with geographic region and phase of pandemic. We identified a body of strategies that were both commonly used and sustained over time, for example, limiting staff in COVID-19 rooms and increasing telehealth capacity, as well as those that were rarely used and/or not sustained, for example, increasing hospital bed capacity.Conclusions Hospital strategies during the COVID-19 pandemic varied in resource intensity, uptake and duration of use. Such information may be valuable to health systems during the ongoing pandemic and future ones.
