Hospitals strained in 2017-2018 influenza season, but did not plan for future pandemic

Although hospitals in the United States reported experiencing strain during the 2017-2018 influenza epidemic, they did not consider pandemic preparedness planning a high priority, according to research published in JAMA Network Open.

“The timing for our survey couldn’t have been better; ultimately it serves as a pre-COVID-19 time capsule of our preparedness to accommodate surges in patients needing hospitalization for acute illness,” David Wallace, MD, MPH, associate professor in the departments of critical care medicine and emergency medicine at the University of Pittsburgh, said in a press release. “It was surprising to hear very detailed stories of the strain hospitals were under during the 2017-2018 flu season, and yet have no pandemic planning come out of it.”

In their qualitative study, Wallace and colleagues used semi-structured phone interviews from a random sample of capacity management administrators at short-term acute care hospitals from 25 states in all geographic regions across the U.S. These administrators were responsible for hospital capacity and throughput at their institution.

A total of 53 hospital capacity personnel at 53 different hospitals were included in the study. Among these personnel, 90.6% had a nursing background and 54.7% had been in their role for longer than 4 years.

Hospitals’ experiences during the 2017-2018 influenza season included perception of strain, effects of influenza and influenza-like illness on staffing and patient care, immediate responses to staffing and capacity from influenza and influenza-like illness, and future stagging and capacity preparedness from these illnesses.

All surveyed participants reported that their hospitals experienced strain in the 2017-2018 influenza season, and that strain was typically described as a consequence of high occupancy while the demand for resources was greater than what was available.

Wallace and colleagues noted that capacity personnel reported perceived strain that was associated with concerns about preparedness of influenza and similar illnesses, staffing, patient care and capacity, but they did not report planning for a future pandemic as a high priority.

According to the researchers, the HHS office of the Assistant Secretary for Preparedness and Response developed an Interim Healthcare Coalition Checklist for Pandemic Planning report, which consists of eight categories for hospitals to address in planning for crises. They found that while some of these domains were described by each surveyed individual in the study, no single individual commented on every domain, and none of the participants specifically reported using the checklist in capacity management or while planning for future pandemics.

“Hospitals have a tendency to deal with what’s right in front of them, the present,” Wallace said in the release. “In doing that, we must also learn when certain levers — like a pandemic preparedness checklist — must be pulled. That is done through reflecting after a crisis subsides and looking for opportunities to improve before the next crisis hits.”

He added that “if the past year has taught us anything, it’s that infectious diseases aren’t going away, and we’ll always get a chance to put lessons learned to work.”

References:

Eurekalert. Survey of Hospital Surge Capacity Years Before COVID-19 Gives Insight into Pandemic Preparedness. https://www.eurekalert.org/pub_releases/2021-03/uop-hsc031621.php. Accessed March 19, 2021.

Harris GH, et al. JAMA Netw Open. 2021;doi: 10.1001/jamanetworkopen.2021.2382.