An inability to quickly diagnose COVID-19 patients in a timely manner meant that hospitals had to assume that all symptomatic patients and staff were infected until results showed otherwise.
A shortage of COVID-19 testing kits, and lengthy waits for test results were identified as root problems that created bottlenecks for the nation's hospitals as the coronavirus pandemic gained momentum late last month, a new federal audit shows.
The scarcity of the tests, and the subsequent wait for results for patients and staff, which often took a week or longer, had a snowball effect on patient throughput, according to a survey and analysis by the Department of Health and Human Services' Office of the Inspector General.
The inability to quickly diagnose COVID-19 patients in a timely manner meant that hospitals had to assume that all symptomatic patients and staff were infected until results showed otherwise.
That delay sideline staff suspected of contracting the virus, who were quarantined; which strained remaining staff; kept patients in acute care hospital beds longer, and delayed transfer to nursing homes or other post-acute care settings until a diagnosis could be verified; directed more scarce resources, such as personal protective equipment, for patients in diagnostic limbo; which also made it harder for hospitals to free up bed capacity in anticipation of a surge in new patients, the survey found.
"Sitting with 60 patients with presumed positives in our hospital isn't healthy for anybody," one administrator told OIG in its March 23-27 telephone survey of 323 randomly selected hospitals across the nation.
"Hospitals reported that their most significant challenges centered on testing and caring for patients with known or suspected COVID-19 and keeping staff safe" OIG said. "Hospitals said that severe shortages of testing supplies and extended waits for test results limited hospitals' ability to monitor the health of patients and staff."
"They also reported that widespread shortages of personal protective equipment (PPE) put staff and patients at risk. In addition, hospitals said that they were not always able to maintain adequate staffing levels or to offer staff adequate support," OIG said.
"Administrators also expressed concern that fear and uncertainty were taking an emotional toll on staff, both professionally and personally," OIG said.
'We are all competing for the same items.'
The hospitals described a mad scramble to acquire testing kits, PPE, no-touch infrared thermometers, ventilators, and other supplies, and often found themselves competing with other hospitals and the general public for the scare resources. "We are all competing for the same items and there are only so many people on the other end of the supply chain," one administrator told auditors.
Hospitals also complained of little coordination or oversight – and sometimes conflicting guidance – from the federal government.
"Hospitals often stated that they were in competition with other providers for limited supplies, and that government intervention and coordination could help reconcile this problem at the national level to provide equitable distribution of supplies throughout the country," OIG said.
Another administrator told OIG that the hospital normally used 200 masks daily, but was now using 2,000 per day. Another hospital administrator said the "fear factor" prompted all staff to wear masks, not just those clinicians treating COVID-19 patients. Another administrator reported that a box of 2,500 N95 masks obtained from a state strategic reserve was unusable because the elastic straps had dry-rotted. Another administrator said that masks that usually cost 50 cents now cost $6 apiece.
When supplies could not be found and staffing shortages threatened care, OIG said hospitals improvised "a range of strategies to maintain or expand their capacity to care for patients and to keep staff safe," including "sometimes un-vetted, and non-traditional sources of supplies and medical equipment."
That included reusing disposable PPE, using homemade or construction face masks, and "jerry-rigging" anesthesia machines as ventilators.
To alleviate clinician shortages, hospitals trained anesthesiologists, hospitalists, and nurses to operate ventilators.
To support staff, hospitals provided childcare, laundry and grocery services, and hotel rooms to promote separation from elderly family members.
To manage patient flow and hospital capacity, some hospitals provided outpatient or telehealth care for patients with less-severe symptoms, and set up alternate care venues at fairgrounds, college dorms, and even empty jails.
On top of all this, hospital administrators reported that the increased costs of care, coupled with the decreased revenues from the postponement of lucrative elective surgeries and other procedures, posed "a threat to their financial viability," OIG said.
The administrators who spoke with OIG frequently expressed concerns about ongoing staffing and equipment shortages if the pandemic stretches into the summer and beyond.
"Unlike a disaster where the surge is over in a matter of days, with this situation we have to prepare for this to last many months," one administrator said. "We have to scale up in equipment and staff, and prepare for this to last a long, long time. This is very challenging for staff."
Since the survey was taken, OIG noted that the federal government has taken steps to address the shortages and concerns raised by hospitals, which includes a $110 billion aid package passed by Congress in late March.
“Hospitals reported that their most significant challenges centered on testing and caring for patients with known or suspected COVID-19 and keeping staff safe.”
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.
Testing delays sideline staff suspected of contracting the virus, which strained remaining staff.
The delays also kept patients in acute care hospital beds longer, and delayed transfer to nursing homes or other post-acute care settings until a diagnosis could be confirmed.
Delays meant that scarce resources had to be used for patients in diagnostic limbo, which made it harder for hospitals to free up bed capacity.