Operationally, the pandemic has exposed many challenges and opportunities. Institutions across the country swiftly implemented key adaptations at the organization, team, and provider level in order to care for a large surge of medically complex and highly infectious patients. Many of the institutions had implemented similar types of surge plans, though many of the tactics were not necessarily implemented at the time of our work we will continue to re-evaluate as geographic areas continue to have surges.

While there were many similarities across sites, there were some differing strategies in particular around staffing with either higher versus lower census. Geographic cohorting has been a notorious hot topic in the hospital medicine literature with many places historically having difficulties around operationalizing it. However, in this setting institutions were able to eliminate those previous barriers and prioritize this patient population with 79% of sites reporting geographic localization. A new and emerging area is in the use of virtual visits of hospitalized patients with 55% of sites reporting its use. While communities across the country have planned and built community surge areas, at the time of our survey only 12% of sites used community surge areas.

Areas for future work that will be important to understand will be assessing the effectiveness of these adaptations on patient and provider level outcomes as well as operational and financial impacts on institutions. The pandemic has highlighted just how nimble our institutions, providers, staff, and patients can be and offers the opportunity to understand and highlight best practices.