Observational study of organisational responses of 17 US hospitals over the first year of the COVID-19 pandemic

Esther K. Choo*, Matthew Strehlow, Marina Del Rios, Evrim Oral, Ruth Pobee, Andrew Nugent, Stephen Lim, Christian Hext, Sarah Newhall, Diana Ko, Srihari V. Chari, Amy Wilson, Joshua J. Baugh, David Callaway, Mucio Kit Delgado, Zoe Glick, Christian J. Graulty, Nicholas Hall, Abdusebur Jemal, Madhav KcAditya Mahadevan, Milap Mehta, Andrew C. Meltzer, Dar'Ya Pozhidayeva, Daniel Resnick-Ault, Christian Schulz, Sam Shen, Lauren Southerland, Daniel Du Pont, Danielle M. McCarthy

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objectives The COVID-19 pandemic has required significant modifications of hospital care. The objective of this study was to examine the operational approaches taken by US hospitals over time in response to the COVID-19 pandemic. Design, setting and participants This was a prospective observational study of 17 geographically diverse US hospitals from February 2020 to February 2021. Outcomes and analysis We identified 42 potential pandemic-related strategies and obtained week-to-week data about their use. We calculated descriptive statistics for use of each strategy and plotted percent uptake and weeks used. We assessed the relationship between strategy use and hospital type, geographic region and phase of the pandemic using generalised estimating equations (GEEs), adjusting for weekly county case counts. Results We found heterogeneity in strategy uptake over time, some of which was associated with geographic region and phase of pandemic. We identified a body of strategies that were both commonly used and sustained over time, for example, limiting staff in COVID-19 rooms and increasing telehealth capacity, as well as those that were rarely used and/or not sustained, for example, increasing hospital bed capacity. Conclusions Hospital strategies during the COVID-19 pandemic varied in resource intensity, uptake and duration of use. Such information may be valuable to health systems during the ongoing pandemic and future ones.

Original languageEnglish (US)
Article numbere067986
JournalBMJ open
Issue number5
StatePublished - May 8 2023


  • COVID-19
  • Organisation of health services
  • Protocols & guidelines

ASJC Scopus subject areas

  • Medicine(all)


Dive into the research topics of 'Observational study of organisational responses of 17 US hospitals over the first year of the COVID-19 pandemic'. Together they form a unique fingerprint.

Cite this