Observational studyCritical care medicine2021
Variation in Initial U.S. Hospital Responses to the Coronavirus Disease 2019 Pandemic.
Observational study in Critical care medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
29 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Guideline
- Predictors of Respiratory Support Use in Emergency Department Patients With COVID-19-Related Respiratory Failure.Respiratory care · 2022Trial
- Classifying healthcare facilities as predictors of COVID-19 mortality rates in US counties (2020-2021).Journal of public health (Oxford, England) · 2026Article
- Protection or constraint? A phenomenological study of the learning experience among doctors receiving postgraduate medical education during the COVID-19 pandemic.BMC medical education · 2026Article
- Patients' Experiences of Care During Hospitalization for Acute Respiratory Failure During COVID-19: A Multi-Center Qualitative Study.Journal of patient experience · 2026Article
- Using prescription medication utilization trends to evaluate health system resilience and inform future emergency preparedness.Journal of managed care & specialty pharmacy · 2026Article
- Integrated health systems and medical care quality during the COVID-19 pandemic.Health services research · 2025Article
- Experiences of U.S. frontline physicians during the COVID-19 pandemic: a qualitative study.Archives of public health = Archives belges de sante publique · 2025Article
- Article
- Regulatory technology arrangements for hospital bed access during the COVID-19 pandemic: scope review.Cadernos de saude publica · 2025Article
- Trends in inpatient versus outpatient upper extremity fracture surgery from 2008 to 2021 and their implications for equitable access: a retrospective cohort study.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2024Article
- Cancellation and Resumption of Elective Surgeries Over Time Across a National Sample of US Hospitals During the COVID-19 Pandemic.CHEST critical care · 2024Article
- Equity evaluation of intensive care unit admission based on comorbidity in hospitalized patients with COVID-19: a cross-sectional analysis.Frontiers in public health · 2024Article
- Impact of the COVID-19 Pandemic on Inpatient Utilization for Acute Neurologic Disease.The Neurohospitalist · 2024Article
- Surge Capacity in the COVID-19 Era: a Natural Experiment of Neurocritical Care in General Critical Care.Neurocritical care · 2023Observational
- Critical Care Among Disadvantaged Minority Groups Made Equitable: Trends Throughout the COVID-19 Pandemic.Journal of racial and ethnic health disparities · 2023Article
- Surge in Incidence and Coronavirus Disease 2019 Hospital Risk of Death, United States, September 2020 to March 2021.Open forum infectious diseases · 2022Article
- Understanding the Impact of Intensive Care Unit Personnel on Intensive Care Unit Mortality during Times of High Demand.Annals of the American Thoracic Society · 2022Article
- Mortality of Mechanically Ventilated COVID-19 Patients in Traditional versus Expanded Intensive Care Units in New York.Annals of the American Thoracic Society · 2022Article
- The Influence of the COVID-19 Pandemic on Intensivists' Well-Being: A Qualitative Study.Chest · 2022Article
Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
objectivesThe coronavirus disease 2019 pandemic has strained many healthcare systems. In response, U.S. hospitals altered their care delivery systems, but there are few data regarding specific structural changes. Understanding these changes is important to guide interpretation of outcomes and inform pandemic preparedness. We sought to characterize emergency responses across hospitals in the United States over time and in the context of local case rates early in the coronavirus disease 2019 pandemic.
designWe surveyed hospitals from a national acute care trials group regarding operational and structural changes made in response to the coronavirus disease 2019 pandemic from January to August 2020. We collected prepandemic characteristics and changes to hospital system, space, staffing, and equipment during the pandemic. We compared the timing of these changes with county-level coronavirus disease 2019 case rates. SETTING AND
participantsU.S. hospitals participating in the Prevention and Early Treatment of Acute Lung Injury Network Coronavirus Disease 2019 Observational study. Site investigators at each hospital collected local data.
interventionsNone. MEASUREMENTS AND MAIN
resultsForty-five sites participated (94% response rate). System-level changes (incident command activation and elective procedure cancellation) occurred at nearly all sites, preceding rises in local case rates. The peak inpatient census during the pandemic was greater than the prior hospital bed capacity in 57% of sites with notable regional variation. Nearly half (49%) expanded ward capacity, and 63% expanded ICU capacity, with nearly all bed expansion achieved through repurposing of clinical spaces. Two-thirds of sites adapted staffing to care for patients with coronavirus disease 2019, with 48% implementing tiered staffing models, 49% adding temporary physicians, nurses, or respiratory therapists, and 30% changing the ratios of physicians or nurses to patients.
conclusionsThe coronavirus disease 2019 pandemic prompted widespread system-level changes, but front-line clinical care varied widely according to specific hospital needs and infrastructure. Linking operational changes to care delivery processes is a necessary step to understand the impact of the coronavirus disease 2019 pandemic on patient outcomes.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.