Comparison of the Impact of COVID-19 on Veterans Affairs and Non-federal Hospitals: a Survey of Infection Prevention Specialists

Richard J Schildhouse; Ashwin Gupta; M Todd Greene; Karen E Fowler; David Ratz; Mark S Hausman; Sanjay Saint

doi:10.1007/s11606-022-07961-z

Comparison of the Impact of COVID-19 on Veterans Affairs and Non-federal Hospitals: a Survey of Infection Prevention Specialists

J Gen Intern Med. 2023 Feb;38(2):450-455. doi: 10.1007/s11606-022-07961-z. Epub 2022 Nov 30.

Authors

Richard J Schildhouse^{1

2}, Ashwin Gupta^{3

4

5}, M Todd Greene^{3

4

5}, Karen E Fowler^{3

5}, David Ratz^{3

5}, Mark S Hausman^{3

6}, Sanjay Saint^{3

4

5}

Affiliations

¹ VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. rschildh@med.umich.edu.
² Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. rschildh@med.umich.edu.
³ VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
⁴ Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
⁵ VA/UM Patient Safety Enhancement Program, Ann Arbor, MI, USA.
⁶ Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA.

Abstract

Background: As the COVID-19 pandemic evolves, it is critical to understand characteristics that have allowed US healthcare systems, including the Veterans Affairs (VA) and non-federal hospitals, to mount an effective response in the setting of limited resources and unpredictable clinical demands generated by this system shock.

Objective: To compare the impact of and response to resource shortages to both VA and non-federal healthcare systems during the COVID-19 pandemic.

Design: Cross-sectional national survey administered April 2021 through May 2022.

Participants: Lead infection preventionists from VA and non-federal hospitals across the US.

Main measures: Surveys collected hospital demographic factors along with 11 questions aimed at assessing the effectiveness of the hospital's COVID response.

Key results: The response rate was 56% (71/127) from VA and 47% (415/881) from non-federal hospitals. Compared to VA hospitals, non-federal hospitals had a larger average number of acute care (214 vs. 103 beds, p<.001) and intensive care unit (24 vs. 16, p<.001) beds. VA hospitals were more likely to report no shortages of personal protective equipment or medical supplies during the pandemic (17% vs. 9%, p=.03) and more frequently opened new units to care specifically for COVID patients (71% vs. 49%, p<.001) compared with non-federal hospitals. Non-federal hospitals more frequently experienced increased loss of staff due to resignations (76% vs. 53%, p=.001) and financial hardships stemming from the pandemic (58% vs. 7%, p<0.001).

Conclusions: In our survey-based national study, lead infection preventionists noted several distinct advantages in VA versus non-federal hospitals in their ability to expand bed capacity, retain staff, mitigate supply shortages, and avoid financial hardship. While these benefits appear to be inherent to the VA's structure, non-federal hospitals can adapt their infrastructure to better weather future system shocks.

Keywords: COVID-19; health policy; health systems; personal protective equipment; system shock.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

COVID-19*
Cross-Sectional Studies
Hospitals
Hospitals, Veterans
Humans
Pandemics
United States
United States Department of Veterans Affairs
Veterans*