Healthcare systems’ responses to the first wave of the COVID-19 pandemic varied, but most canceled elective procedures to preserve intensive care unit (ICU) capacity and adapted staffing and physical space to prepare for patient surges, according to the results of a recent study.1
“Hospitals in the first phase learned a little about what worked and what didn’t work, and what was needed and what was not needed,” says Meeta Prasad Kerlin, MD, MS, lead study author and associate professor of medicine, pulmonary, allergy, and critical care division at the University of Pennsylvania’s Perelman School of Medicine. “One example was elective surgery. Almost all hospitals canceled surgeries and procedures in the spring of 2020 in preparation for having more beds, more staff for COVID.”
But fewer surgeries were canceled during the surge in the winter of 2020-2021.2 “I think that’s because we learned that it didn’t improve our efficiencies, and we didn’t need to impede the care of non-COVID patients to improve the care of COVID patients,” Kerlin says.
Another difference is how hospitals dedicated space for patients with COVID-19. In the first phase of the pandemic, many hospitals created dedicated space for these patients, largely due to uncertainty about virus transmission, and the need to use personal protective equipment (PPE) efficiently.
“In the second phase, that was much less the case because we had learned how to take better care of COVID patients and to keep healthcare workers safe, even if patients were not all dedicated in one unit,” Kerlin adds.
With the omicron wave, health systems found one of their biggest challenges was unprecedented numbers of staff out sick with COVID-19. “This was despite having good PPE and people being vaccinated,” Kerlin says.
As health systems enter the third year of the pandemic, the challenges related to staff turnover and burnout are increasing — and should be a leadership priority.
“We need system-level attention and intervention that is focused on understanding and appreciating the needs and addressing the burnout that comes with it,” Kerlin says. “At a minimum, we need to acknowledge and appreciate the hard work healthcare workers are doing.”
Healthcare leaders also should implement changes to help alleviate staff stress, including public gestures of appreciation, such as billboards that thank healthcare workers.
“I was reading an [op-ed/article]3 somewhere about how at the start of the pandemic, there was appreciation for healthcare workers, and two years later, all of that is gone,” Kerlin says. “We need to renew the sense of appreciation, such as billboards of healthcare workers — but maybe that’s not enough.”
Hospital workers are experiencing disdain and threats of violence from family members of patients and others. In a September 2021 survey, more than 30% of hospital nurses reported an increase in workplace violence.3,4
“One way to start recognizing and appreciating staff is to listen to them about what they feel they need,” Kerlin says. “A big challenge might be that what is needed most is more staffing. That’s hard to come by right now because the workforce is diminished.”
Kerlin and colleagues asked about triage policies and whether health systems were undertaking any policies related to crisis standards of care, such as who can or cannot receive a ventilator, or who can or cannot be admitted to the hospital.
“Largely, in 2020, hospitals said they were prepared for triage, but didn’t have to implement it,” Kerlin says. “The hospitals were not completely overwhelmed in the winter of 2020-21. But there’s a lot of concern that omicron is going to push hospitals into thinking about all of those things again.”
For example, some hospitals in small networks or regions might have to make triage plans because of the speed and ferocity of the omicron surge.
“We do see omicron is less severe and has a lower rate of critical illness,” Kerlin explains. “But the point is that even a small percentage of hospitalization of millions of people sick at the same time can tip things over.”
REFERENCES
- Kerlin MP, Costa, DK, Davis BS, et al. Actions taken by US hospitals to prepare for increased demand for intensive care during the first wave of COVID-19: A national survey. Chest 2021;160:519-528.
- Mattingly AS, Rose L, Eddington HS, et al. Trends in US surgical procedures and health care system responses to policies curtailing elective surgical operations during the COVID-19 pandemic. JAMA Netw Open 2021;4:e2138038.
- Sable-Smith B, Miller A. Once hailed as heroes, health care workers now face a rash of violence. Kaiser Health News. Oct. 10, 2021.
- National Nurses United. National nurse survey reveals that health care employers need to do more to comply with OSHA emergency temporary standard. Sept. 27, 2021.
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