Hospitals and health systems are wrestling with a host of problems related to the COVID-19 coronavirus. This is widely known, but a new Office of the Inspector General report shows a new wrinkle: The problems – including insufficient tests, slow results, shortages of personal protective equipment and a shortage of ventilators for critically ill patients – are interconnected, and are making each other worse in a toxic cycle.
These various challenges are playing off of each other and exacerbating the situation through a kind of domino effect, according to the report from the U.S. Department of Health and Human Services' Office of the Inspector General.
And this phenomenon is widespread. The report claims three out of four hospitals that responded to its survey are already treating patients with suspected or confirmed COVID-19.
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The report is based on brief telephone interviews, conducted March 23-27, with hospital administrators from 323 hospitals across 46 States, Washington, D.C., and Puerto Rico.
WHAT'S THE IMPACT?
Hospitals said their most significant challenges centered on testing and caring for patients with COVID-19 and keeping staff safe. Severe shortages of testing supplies and extended waits for test results limited hospitals' ability to monitor the health of patients and staff, and widespread shortages of PPE are putting both staff and patients at risk. Hospitals also said they were not always able to maintain adequate staffing levels or to offer staff adequate support.
They 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.
In addition to widespread shortages of critical supplies, ventilators and logistic support, hospitals also described increasing costs and decreasing revenues as a threat to their financial viability, and said that sometimes inconsistent guidance from federal, state and local authorities posed challenges and confused both hospitals and the public.
Hospitals reported using a range of strategies to maintain or expand their capacity to care for patients and keep staff safe. To secure the necessary PPE, equipment and supplies, hospital administrators reported turning to new, sometimes un-vetted and nontraditional 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 and telehealth services when possible. Some are setting up alternate facilities such as fairgrounds, non-operating college dorms and closed correctional facilities as additional space for patient care.
THE LARGER TREND
Healthcare workers face another risk: burnout due to overstress in an increasingly burdened healthcare system. A paper published in JAMA in mid-March found the combination of stress and possible exposure puts healthcare professionals, from physicians, to nurses, to specialists, at greater risk of contracting COVID-19, and potentially spreading it to others.
It's the classic rock-and-a-hard-place scenario – healthcare workers and caregivers are desperately needed during the global response to the outbreak, but represent one of the most vulnerable populations in terms of contracting the highly virulent disease.
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