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

Abstract

BackgroundAs 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.ObjectiveTo compare the impact of and response to resource shortages to both VA and non-federal healthcare systems during the COVID-19 pandemic.DesignCross-sectional national survey administered April 2021 through May 2022.ParticipantsLead infection preventionists from VA and non-federal hospitals across the US.Main MeasuresSurveys collected hospital demographic factors along with 11 questions aimed at assessing the effectiveness of the hospital’s COVID response.Key ResultsThe 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).ConclusionsIn 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.