Observational study of organisational responses of 17 US hospitals over the first year of the COVID-19 pandemic

Esther K. Choo, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA echomd@gmail.com.
Matthew Strehlow, Department of Emergency Medicine, Stanford University, Stanford, California, USA.
Marina Del Rios, Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA.
Evrim Oral, Department of Biostatistics, School of Public Health LSU Health Sciences Center, New Orleans, Louisiana, 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.
Stephen Lim, Section of Emergency Medicine, Department of Medicine, University Medical Center New Orleans, LSU Health Sciences Center New Orleans, New Orleans, Louisiana, 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.
Srihari V. Chari, Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Amy Wilson, Oregon Clinical and Translational Research Institute (OCTRI), Oregon Health & Science University, Portland, Oregon, 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.
Madhav Kc, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center (COPPER) Center, Yale School of Medicine, New Haven, Connecticut, USA.
Aditya Mahadevan, Department of Emergency Medicine, Stanford University, Stanford, California, 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.
Christian Schulz, Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA.
Sam Shen, Department of Emergency Medicine Medicine, Stanford University, Palo Alto, California, USA.
Lauren Southerland, Department of Emergency Medicine, Ohio State University, Columbus, Ohio, USA.
Daniel Du Pont, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Danielle M. McCarthy, Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.

Document Type

Journal Article

Publication Date

5-8-2023

Journal

BMJ open

Volume

13

Issue

5

DOI

10.1136/bmjopen-2022-067986

Keywords

COVID-19; HEALTH SERVICES ADMINISTRATION & MANAGEMENT; Organisation of health services; PUBLIC HEALTH; Protocols & guidelines

Abstract

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.

Department

Emergency Medicine

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