Actions Taken by US Hospitals to Prepare for Increased Demand for Intensive Care During the First Wave of COVID-19: A National Survey

Background: The COVID-19 pandemic placed considerable strain on critical care resources. How US hospitals responded to this crisis is unknown. Research Question: What actions did US hospitals take to prepare for a potential surge in demand for critical care services in the context of the COVID-19 pandemic? Study Design and Methods: From September to November 2020, the chief nursing officers of a representative sample of US hospitals were surveyed regarding organizational actions taken to increase or maintain critical care capacity during the COVID-19 pandemic. Weighted proportions of hospitals for each potential action were calculated to create estimates across the entire population of US hospitals, accounting for both the sampling strategy and nonresponse. Also examined was whether the types of actions taken varied according to the cumulative regional incidence of COVID-19 cases. Results: Responses were received from 169 of 540 surveyed US hospitals (response rate, 31.3%). Almost all hospitals canceled or postponed elective surgeries (96.7%) and nonsurgical procedures (94.8%). Few hospitals created new medical units in areas not typically dedicated to health care (12.9%), and almost none adopted triage protocols (5.6%) or protocols to connect multiple patients to a single ventilator (4.8%). Actions to increase or preserve ICU staff, including use of ICU telemedicine, were highly variable, without any single dominant strategy. Hospitals experiencing a higher incidence of COVID-19 did not consistently take different actions compared with hospitals facing lower incidence. Interpretation: Responses of hospitals to the mass need for critical care services due to the COVID-19 pandemic were highly variable. Most hospitals canceled procedures to preserve ICU capacity and scaled up ICU capacity using existing clinical space and staffing. Future research linking hospital response to patient outcomes can inform planning for additional surges of this pandemic or other events in the future.