OIG recently released the results of a survey conducted from March 23-27 in which OIG asked hospital administrators from 323 hospitals across the U.S. to opine on the most significant challenges relating to the current pandemic and their strategies for mitigation. The greatest challenges reported include severe shortages of testing supplies, personal protective equipment (PPE), and ventilators, as well as general supplies such as IV poles, cleaning supplies, food, and linens. Additionally, administrators expressed concerns with staffing shortages, obstacles to expanding capacity, decreasing revenues, inconsistent guidance from governmental authorities, and delays in testing. Below is a summary of various novel, and in some cases drastic, measures highlighted in the report that hospitals are using to address these challenges.

Strategies to secure necessary PPE and supplies include:

• Using nontraditional sources, such as online retailers, home supply stores, paint stores, autobody supply shops, and beauty salons.
• Repurposing PPE from non-medical industries.
• Purchasing expired PPE.
• Using substitute materials (e.g., sandwich bags as thermometer covers).
• Physically securing PPE to prevent theft or misuse.
• Limiting PPE use to more intensive care settings.
• Sterilizing and reusing PPE.

Strategies to address ventilator shortages include:

• Renting ventilators or buying single-use emergency transport ventilators.
• Entering sharing arrangements or patient-transfer arrangements with affiliated and non-affiliated facilities.
• Converting anesthesia machines and bi-level positive airway pressure machines.
• Fitting ventilators with additional hoses to connect multiple patients.

Strategies to address staffing needs include:

• Providing assistance to staff with childcare, grocery deliveries, and laundry services in order to promote retention.
• Offering hotel accommodations to staff needing to separate from elderly family members.
• Cross-training staff (e.g., training anesthesiologists, hospitalists, and nurses to operate ventilators, and training non-emergency department physicians to assist with triage in emergency departments).
• Supplementing with contractors, retired providers, nurse aids, and medical students.
• Implementing screening centers outside hospitals to help prevent COVID-19 from spreading among staff.
• Providing mental health clinicians for emotional and psychological support.

Strategies to deal with patient flow and capacity include:

• Using ambulatory care providers and telehealth to triage patients outside of hospitals in clinics, in their cars, or over the phone.
• Limiting the number of physical entrances and restricting access to common areas (e.g., making cafeterias take-out only).
• Restricting visitors and dismissing volunteers performing nonessential services.
• Splitting emergency departments into separate areas for respiratory and non-respiratory patients.
• Converting an ambulance bay into a respiratory assessment unit with portable x-ray machines.
• Establishing alternate care sites at local fairgrounds, vacated college dorms, and other facilities.
• Eliminating elective procedures and reducing nonemergency services.
• Reassigning clinic-based physicians to hospitals.
• Using a buddy system to pair intensive and non-intensive providers together.

Strategies to protect financial viability include:

• Using a line of credit to support payroll.
• Reducing unnecessary inventory.
• Evaluating pay cuts, furloughs, and layoffs.
• Implementing mandatory and voluntary time off for nonessential staff.
• Seeking grants and other funding opportunities.

For a copy of the OIG survey report, Hospital Experiences Responding to the COVID-19 Pandemic: Results of a National Pulse Survey March 23–27, 2020, please click here.