Priorities for Healthcare Systems Emergency Preparedness in Inpatient Settings Informed by COVID-19: An Official American Thoracic Society Workshop Report

This workshop identified a set of core system-level care delivery priorities that emerged during the coronavirus disease (COVID-19) pandemic to assist global healthcare systems to respond to future similar emergencies using an informed and systematic approach. Led by a working group (<i>n</i> = 14) of nurses and physicians with diverse clinical and administrative backgrounds, we conducted a literature review of staffing, supplies, and systems in hospital inpatient settings to inform potential candidate priorities of COVID-19 care delivery challenges. We then used a modified Delphi consensus approach to elicit expert opinion from clinicians, healthcare and public health administrators, and health services researchers. Three rounds of online surveys were completed. To retain survey items, we <i>a priori</i> determined a threshold of 75% or greater endorsement for items rated "highly important to essential." A total of 47 international experts responded. Forty of 71 care delivery priorities were retained. These 40 priorities comprised 25 systems (8 related to infrastructure [e.g., systemic enhanced support from federal resources during a pandemic]; 8 to care delivery [e.g., policies in place and operational for rationing of care]; and 9 to training, infection control, and communication [e.g., training for healthcare workers on protocols and/or processes for rapid testing]), 11 related to supplies (e.g., safe handling of biomedical waste), and 4 related to staffing (e.g., programs and/or systems to support staff retention). By organizing these priorities on the basis of implementation complexity and applying relevant frameworks, the project offers strategies to inform investment and guide global healthcare systems in pandemic preparedness planning for the future.