Hospitals to OIG: Lack of tests, PPE and consistent guidance hamstringing COVID-19 response

Severe shortages of testing supplies and extended waits for test results have limited hospitals' ability to monitor the health of patients and staff, according to a new report from a federal watchdog. 

Hospitals also reported that widespread shortages of personal protective equipment (PPE) put staff and patients at risk, and they were not always able to maintain adequate staffing levels or to offer staff adequate support. 

Those are among the experiences captured in a snapshot report produced by the Department of Health and Human Services' (HHS') Office of Inspector General (OIG). The OIG surveyed a random sample of hospital administrators from 323 hospitals across 46 states, the District of Columbia and Puerto Rico the week of March 23 to provide a look at hospitals' challenges and needs in responding to the pandemic. 

Across the industry, “millions [of tests] are needed, and we only have hundreds," one administrator said in response to the survey.

"We recognize that HHS, Congress, and other federal, state, local and tribal government entities are taking substantial actions on a continual basis to support hospitals in responding to COVID-19," the OIG report said, referring to actions such as the Coronavirus Aid, Relief and Economic Security (CARES) Act, which provides the basis for additional actions. "We present this information for HHS and other decision-makers' consideration as they continue to respond to the COVID-19 pandemic."

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Among the other findings, hospitals reporting pressing need for government help when it came to: 

  • Capacity issues: Hospitals described substantial challenges maintaining and expanding capacity to care for patients, the report said. This was exacerbated by the lack of testing availability. "Hospitals reported that some presumptive positive patients remained in the hospital for days while awaiting test results, which reduced the hospitals’ availability of beds for other patients," the report said.
  • Shortages of critical supplies: Hospitals said shortages of critical supplies, materials and logistic support that accompany more beds affected hospitals' ability to care for patients. Hospitals also cited anticipated shortages of ventilators as a potential challenge. Some hospital administrators said they had not received supplies from the Strategic National Stockpile or that the supplies they had received were not sufficient in quantity or quality. "One administrator stated that getting supplies from the stockpile was a major challenge, saying that the supplies the hospital received 'won't even last a day. We need gloves, we need masks with fluid shields on—N95 masks—and we need gowns. It's the number one challenge all across the system,'" the report said.
  • Cash crunches: Hospitals said they were facing the dual threat of increasing costs and decreasing revenues as a threat to their financial viability. For instance, multiple hospitals reported concerns that prices of equipment, particularly masks, had increased significantly. "Many hospitals reported that their cash reserves were quickly depleting, which could disrupt ongoing hospital operations," the report said. "All types of hospitals, and especially small rural hospitals, requested financial assistance, including faster and increased Medicare payments, and loans and grants."
  • Inconsistent guidance: Hospitals said changing and sometimes inconsistent guidance from federal, state and local authorities confused hospital officials and the public. "Hospitals reported that it was sometimes difficult to remain current with Centers for Disease Control and Prevention (CDC) guidance and that they received conflicting guidance from different government and medical authorities, including criteria for testing, determining which elective procedures to delay, use of PPE, and getting supplies from the national stockpile," the report said.

The survey found hospitals were using a range of strategies to expand their capacity. For example, hospital administrators reported turning to new and sometimes unproved and nontraditional sources of supplies and medical equipment in order to make sure they have enough PPE, ventilators and other supplies for their staff.

"Instead of reusing medical-grade equipment, some hospitals reported resorting to non-medical-grade PPE such as construction masks or handmade masks and gowns, but were unsure about the guidelines for how to safely do it," the report said. 

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Hospital administrators also indicated they were training medical staff like anesthesiologists, hospitalists and nursing staff to help care for patients on ventilators. Some hospitals reported providing services such as childcare, laundry, grocery services and hotel accommodations that promote separation from elderly family members. 

Some hospitals were providing ambulatory care for patients with less severe symptoms as well as telehealth services when possible and setting up alternate facilities such as fairgrounds, nonoperating college dorms and closed correctional facilities as additional space for patient care.