What GAO found

The COVID-19 pandemic has highlighted the importance of hospitals’ ability to assess and treat an increasing number of patients beyond their normal surgical capacity, known as the medical surge. All eight hospitals in the GAO review reported multiple challenges related to staff, supplies, space, or information. According to the Department of Health and Human Services (HHS), these are key elements of an effective medical surge response. All eight hospitals reported staffing challenges, including a shortage of staff to keep up with the increasing number of patients, and staff being sick and unable to work, impacting hospital services. Hospitals have taken steps to address these challenges. For example, we have supplemented personnel when possible and trained staff in the use of proper personal protective equipment to prevent infection. The Health Care Coalition, a group of health care and response organizations in defined geographic locations supported by HHS funding, assisted the hospital. For example, it coordinated patient transfers to spread hospital load, obtained and distributed needed medical supplies, and communicated hospital needs to states.

Healthcare workers responding to the COVID-19 pandemic

HHS has programs and activities aimed at helping hospitals and other healthcare facilities prepare for medical surges, but it is too early to know the effectiveness of these efforts. For example, HHS plans to conduct a new medical surge exercise for the Union in 2021 to test readiness and set targets to measure performance. We are also looking at how we can use the findings and lessons learned from our assessment of the Coalition during the 2021 pandemic to improve our support to the Coalition and its communities. HHS is also funding the development of the Regional Disaster Health Response System, which aims to develop an effective approach to responding to medical surges across multiple states. This includes better data sharing on resource and capacity issues, and the development of dedicated teams to respond to different hazards. HHS is considering next steps in expanding this regional system. In addition, HHS develops local guidelines for hospitals and other facilities involved in patient care, as required by law, to enhance medical surge capacity during public health emergencies. Officials did not provide a date for when the guidelines will be published.

Why GAO did this study

HHS leads the nation’s medical and public health preparedness, response and recovery for emergencies and disasters. This includes helping build hospitals and other medical surge preparedness systems. Emergencies such as the COVID-19 pandemic put a tremendous strain on hospitals during crises.

The Pandemic and All Disaster Preparedness and Innovation Act of 2019 includes provisions for the GAO to review its implementation of HHS local preparedness and response guidelines for hospitals and other facilities to increase medical surge capacity. I’m here. HHS said the issuance of these guidelines has been delayed as the response to COVID-19 continues. The CARES Act also includes provisions for GAO to report on the federal government’s response to the pandemic. This report explores (1) the healthcare surge challenges that selected hospitals faced in responding to the COVID-19 pandemic and how the Healthcare Coalition helped in their efforts, and (2) the healthcare surge. Describes selected HHS programs and activities underway to support the response to

To do this work, GAO reviewed HHS and hospital documents. GAO also interviewed HHS officials and representatives from a non-generalizable sample of eight hospitals and eight affiliated associations across three states. These states were selected based on their involvement in HHS regional preparedness and response efforts.

A draft of this report has been submitted to HHS for review and comment. HHS provided technical comments.

For more information, please contact Mary Denigan-Macauley ((202) 512-8552) or DeniganMacauleyM@gao.gov.