Phone interviews with potential top managers at 53 U.S. hospitals about preparing for the 2017-18 flu pandemic revealed a lack of brutal capacity, tight resources, and a low priority of pandemic planning, according to a qualitative study today in Open JAMA Network.
Researchers at Emory University and the University of Pittsburgh conducted the semistructured interviews among a random sample of potential managers at 25 geographically diverse hospitals from April 2018 to January 2019.
Participants said they were gaining weight due to concerns about seasonal flu preparedness, staffing, patient care and hospital capacity but said planning for future pandemics was not a high priority. They described strain as a result of high hospital use when demand for facilities exceeded facilities.
“We found that hospitals experienced significant stress as a result of the 2017-2018 flu season, which was associated with broad self-report outcomes on the ‘4 S’: staff, material, location, and systems, “the authors wrote.” The findings are particularly interesting given the widespread challenges facing hospitals in response to the COVID-19 pandemic. “
Patient care, staff suffered
Caring for a spike in flu patients front-line medical staff, participants said, said they needed to adjust user-nurse ratios to patients. Interviewees also said that increased numbers of meetings increased and changes in bed flow, which led to “significant tax pressures, always thinking of solutions.”
As the staff themselves became ill with the flu or had to stay at home to care for a sick child, other workers had to take on additional responsibilities, bother them. Many interviewees reported that increased needs for respiratory isolation placed a strain on hospital infrastructure as well as the workload of physician and nurse.
Almost all participants reported an increase in patient proliferation and boarding for emergency departments, while some noted reductions in elective treatment centers, worse patient care, and concerns about moving patients from the intensive care unit (ICU) faster than normal.
Many commented on the lack of supplies and equipment, with one commenting, “It put a lot of pressure on our isolation stores and isolation rooms” and another commented, “It affects diet trying to deliver or get luggage … how do you place diet orders for a unit you haven’t even picked up? “
To address staff shortages, hospitals turned to working with employment agencies and temporary travel and nursing facilities and the reassignment of nurses within hospitals. One manager said the hospital was ordering overtime and issuing new flu vaccination policies for staff.
Some hospital areas were also relocated, turning non-square areas into dedicated units for flu patients. One nurse manager said there were promotion plans but it was difficult to buy in, creating barriers to implementation and requiring creativity. One interviewee commented, “Our hospital system ambulance service … took patients out of the ED [emergency department] [and] also off the floors that were ready for release. “
While most participants did not describe future hospital preparation activities, focusing instead on actions taken during the flu season, a few said they had changed policies. sick call and cross-training nurses for future events. Others said account committees had been formed and communications with emergency medical services had been improved, but few mentioned the use of brutal situations.
‘Pre-COVID-19 time capsule’
Senior author David Wallace, MD, said in a press release from the University of Pittsburgh that the timing of their study could not have been better. “Ultimately it serves as a pre-COVID-19 time capsule of our preparation to accommodate surgeons in patients who need to be hospitalized for a serious illness,” he said. It’s a surprise to hear very detailed stories about the pressures hospitals were under during the 2017-18 flu season, but nonetheless pandemic planning has not come out of it. “
Of the 53 ability managers interviewed, 73.6% were women, 88.7% were white, 90.6% had a nursing background, 54.7% had been in post for more than 4 years, and 54.7% had been worked in healthcare for over 4 years — and over 20 years. Hospital bed capacity ranged from less than 250 at 13 hospitals to 500 or more at 19 hospitals, with 31 facilities reporting more than 50 ICU beds.
“Hospitals tend to deal with what is right in front of them, right now,” Wallace said in the news. “In doing so, we also need to learn when certain levers – like a pandemic-ready checklist – need to be pulled,” he said. “That’s done by thinking after an emergency has passed down and looking for opportunities to improve before the next crisis comes. If the past year has taught us nothing, it is that infectious diseases do not go away, and we always get the opportunity to apply lessons learned to work. “
The researchers noted that the 2017-18 flu season was characterized by extreme illness and widespread geographic spread, and lasted longer than previous seasons. The U.S. Centers for Disease Control and Prevention (CDC) estimated that flu that year caused more than 27.7 million medical visits, 959,000 hospitals, and 79,800 deaths. Hospitals for people of all ages were the highest ever since a quarterly flu study began in 2005.
In 2017, the CDC and the Department of Health and Human Services updated the National Influenza Pandemic Preparedness Plan, which included information on health care system preparation and response actions, with a focus on promotion strategies for serious infectious diseases such as flu.