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Hospital Adaptation and Resiliency for Infected and Uninfected Patients During Respiratory Viral Surge Events: From Seasonal Influenza to COVID-19

Research Areas


Acute surge events, in which hospitals face capacity strain from an influx of patients, range from annual respiratory viral seasons dominated by seasonal influenza to rarer and more severe epidemics such as due to novel influenzas (e.g., H1N1) and coronaviruses (e.g., COVID-19, SARS, MERS). Optimizing outcomes for both primarily affected patients and bystander patients admitted during surges, requires that hospitals display: (1) adaptation—the ability to improve care and outcomes for infected patients by implementing new care processes based on accumulated experience, and (2) resiliency—the ability to continue to deliver high quality care to uninfected patients despite the presence of a surge event. However, it is unknown what enables hospitals to display adaptation and resiliency, thereby threatening care quality for all patients during viral surges. While we have shown that outcomes of critically ill patients with COVID-19 improved over time, these temporal changes in outcomes were uneven among hospitals. Thus, while there is evidence that hospitals may adapt their care of infected patients in the most severe of respiratory viral surge events, several important knowledge gaps remain. First, does similar adaptation exist during annual respiratory viral seasons, which are individually less dramatic but account for a greater cumulative public health burden? Second, does adaptation come at the cost of resiliency in caring for the typically more numerous uninfected bystander patients who also require hospitalization during surge events? Finally, what organizational factors may account for variability in hospitals’ adaptation and resiliency?

Partnering Health Systems

Penn Medicine


NIH National Heart, Lung, and Blood Institute (NHLBI)