The less-discussed consequence of healthcare’s labor shortage

Patient Safety and Quality Care Movement - YouTube

The healthcare industry’s staffing shortage crisis has had clear consequences for care delivery and efficiency, forcing some health systems to pause nonemergency surgeries or temporarily close facilities. Less understood is how these shortages are affecting care quality and patient safety. 

A mix of high COVID-19 patient volume and staff departures amid the pandemic has put hospitals at the heart of a national staffing shortage, but there is little national data available to quantify the shortages’ effects on patient care. 

The first hint came last month from a CDC report that found healthcare-associated infections increased significantly in 2020 after years of steady decline. Researchers attributed the increase to challenges related to the pandemic, including staffing shortages and high patient volumes, which limited hospitals’ ability to follow standard infection control practices. 

“That’s probably one of the first real pieces of data — from a large scale dataset — that we’ve seen that gives us some sense of direction of where we’ve been headed with the impact of patient outcomes as a result of the pandemic,” Patricia McGaffigan, RN, vice president of safety programs for the Institute for Healthcare Improvement, told Becker’s. “I think we’re still trying to absorb much of what’s really happening with the impact on patients and families.”

An opaque view into national safety trends

Because of lags in data reporting and analysis, the healthcare industry lacks clear insights into the pandemic’s effect on national safety trends.

National data on safety and quality — such as surveys of patient safety culture from the Agency for Healthcare Research and Quality — can often lag by several quarters to a year, according to Ms. McGaffigan. 

“There [have been] some declines in some of those scores more recently, but it does take a little while to be able to capture those changes and be able to put those changes in perspective,” she said. “One number higher or lower doesn’t necessarily indicate a trend, but it is worth really evaluating really closely.”

For example, 569 sentinel events were reported to the Joint Commission in the first six months of 2021, compared to 437 for the first six months of 2020. However, meaningful conclusions about the events’ frequency and long-term trends cannot be drawn from the dataset, as fewer than 2 percent of all sentinel events are reported to the Joint Commission, the organization estimates.

“We may never have as much data as we want,” said Leah Binder, president and CEO of the Leapfrog Group. She said a main area of concern is CMS withholding certain data amid the pandemic. Previously, the agency has suppressed data for individual hospitals during local crises, but never on such a wide scale, according to Ms. Binder.  

CMS collects and publishes quality data for more than 4,000 hospitals nationwide. The data is refreshed quarterly, with the next update scheduled for October. This update will include additional data for the fourth quarter of 2020.

“It is important to note that CMS provided a blanket extraordinary circumstances exception for Q1 and Q2 2020 data due to the COVID-19 pandemic where data was not required nor reported,” a CMS spokesperson told Becker’s. “In addition, some current hospital data will not be publicly available until about July 2022, while other data will not be available until January 2023 due to data exceptions, different measure reporting periods and the way in which CMS posts data.”

Hospitals that closely monitor their own datasets in more near-term windows may have a better grasp of patient safety trends at a local level. However, their ability to monitor, analyze and interpret that data largely depends on the resources available, Ms. McGaffigan said. The pandemic may have sidelined some of that work for hospitals, as clinical or safety leaders had to shift their priorities and day-to-day activities. 

“There are many other things besides COVID-19 that can harm patients,” Ms. Binder told Becker’s. “Health systems know this well, but given the pandemic, have taken their attention off these issues. Infection control and quality issues are not attended to at the level of seriousness we need them to be.”

What health systems should keep an eye on 

While the industry is still waiting for definitive answers on how staffing shortages have affected patient safety, Ms. Binder and Ms. McGaffigan highlighted a few areas of concern they are watching closely. 

The first is the effect limited visitation policies have had on families — and more than just the emotional toll. Family members and caregivers are a critical player missing in healthcare safety, according to Ms. Binder. 

When hospitals don’t allow visitors, loved ones aren’t able to contribute to care, such as ensuring proper medication administration or communication. Many nurses have said they previously relied a lot on family support and vigilance. The lack of extra monitoring may contribute to the increasing stress healthcare providers are facing and open the door for more medical errors.

Which leads Ms. Binder to her second concern — a culture that doesn’t always respect and prioritize nurses. The pandemic has underscored how vital nurses are, as they are present at every step of the care journey, she continued. 

To promote optimal care, hospitals “need a vibrant, engaged and safe nurse workforce,” Ms. Binder said. “We don’t have that. We don’t have a culture that respects nurses.” 

Diagnostic accuracy is another important area to watch, Ms. McGaffigan said. Diagnostic errors — such as missed or delayed diagnoses, or diagnoses that are not effectively communicated to the patient — were already one of the most sizable care quality challenges hospitals were facing prior to the pandemic. 

“It’s a little bit hard to play out what that crystal ball is going to show, but it is in particular an area that I think would be very, very important to watch,” she said.

Another area to monitor closely is delayed care and its potential consequences for patient outcomes, according to Ms. McGaffigan. Many Americans haven’t kept up with preventive care or have had delays in accessing care. Such delays could not only worsen patients’ health conditions, but also disengage them and prevent them from seeking care when it is available. 

Reinvigorating safety work: Where to start

Ms. McGaffigan suggests healthcare organizations looking to reinvigorate their safety work go back to the basics. Leaders should ensure they have a clear understanding of what their organization’s baseline safety metrics are and how their safety reports have been trending over the past year and a half.

“Look at the foundational aspects of what makes care safe and high-quality,” she said. “Those are very much linked to a lot of the systems, behaviors and practices that need to be prioritized by leaders and effectively translated within and across organizations and care teams.”

She recommended healthcare organizations take a total systems approach to their safety work, by focusing on the following four, interconnected pillars:

  • Culture, leadership and governance
  • Patient and family engagement
  • Learning systems
  • Workforce safety

For example, evidence shows workforce safety is an integral part of patient safety, but it’s not an area that’s systematically measured or evaluated, according to Ms. McGaffigan. Leaders should be aware of this connection and consider whether their patient safety reporting systems address workforce safety concerns or, instead, add on extra work and stress for their staff. 

Safety performance can slip when team members get busy or burdensome work is added to their plates, according to Ms. McGaffigan. She said leaders should be able to identify and prioritize the essential value-added work that must go on at an organization to ensure patients and families will have safe passage through the healthcare system and that care teams are able to operate in the safest and healthiest work environments.

In short, leaders should ask themselves: “What is the burdensome work people are being asked to absorb and what are the essential elements that are associated with safety that you want and need people to be able to stay on top of,” she said.

To improve both staffing shortages and quality of care, health systems must bring nurses higher up in leadership and into C-suite roles, Ms. Binder said. Giving nurses more authority in hospital decisions will make everything safer. Seattle-based Virginia Mason Hospital recently redesigned its operations around nurse priorities and subsequently saw its quality and safety scores go up, according to Ms. Binder. 

“If it’s a good place for a nurse to go, it’s a good place for a patient to go,” Ms. Binder said, noting that the national nursing shortage isn’t just a numbers game; it requires a large culture shift.

Hospitals need to double down on quality improvement efforts, Ms. Binder said. “Many have done the opposite, for good reason, because they are so focused on COVID-19. Because of that, quality improvement efforts have been reduced.”

Ms. Binder urged hospitals not to cut quality improvement staff, noting that this is an extraordinarily dangerous time for patients, and hospitals need all the help they can get monitoring safety. Hospitals shouldn’t start to believe the notion that somehow withdrawing focus on quality will save money or effort.  

“It’s important that the American public knows that we are fighting for healthcare quality and safety — and we have to fight for it, we all do,” Ms. Binder concluded. “We all have to be vigilant.”

Conclusion

The true consequences of healthcare’s labor shortage on patient safety and care quality will become clear once more national data is available. If the CDC’s report on rising HAI rates is any harbinger of what’s to come, it’s clear that health systems must place renewed focus and energy on safety work — even during something as unprecedented as a pandemic. 

The irony isn’t lost on Ms. Binder: Amid a crisis driven by infectious disease, U.S. hospitals are seeing higher rates of other infections.  

“A patient dies once,” she concluded. “They can die from COVID-19 or C. diff. It isn’t enough to prevent one.”

NIH director says it will take ‘weeks’ to understand omicron severity

https://thehill.com/homenews/sunday-talk-shows/583272-nih-director-says-it-will-take-two-three-weeks-to-better

NIH Director Francis Collins: “There's no reason to panic” over omicron yet.

National Institutes of Health (NIH) Director Francis Collins offered caution about the new omicron variant of the coronavirus in a Sunday interview, saying it will take weeks to understand whether it can evade COVID-19 vaccines.

Appearing on “Fox News Sunday,” Collins explained that omicron has more than 30 mutations on its spike protein, which raises the question of how effective the antibodies created by vaccines are against the variant.

“If you’ve raised antibodies against [COVID-19] from previously being infected or from being vaccinated, the question is, will those antibodies still stick to this version of the spike protein, or will they evade that protection? We need to find that out, to be honest, though that’s gonna take two, three weeks in both laboratory and field studies to figure out the answer. And that’s what all of us as scientists want to know,” said Collins.

Collins stressed that the COVID-19 vaccines available in the U.S. have been shown to be effective against previous variants, such as delta, saying that was a good indication they also will work against omicron.

“Given that history, we expect that most likely the current vaccines will be sufficient to provide protection. And especially the boosters will give that additional layer of protection because there’s something about the booster that causes your immune system to really expand its capacity against all kinds of different spike proteins, even ones it hasn’t seen before,” he said.

“Please, Americans, if you’re one of those folks who are sort of waiting to see, this would be a great time to sign up get your booster. Or if you haven’t been vaccinated already, get started. Omicron is one more reason to do this,” he added.

NIH director says omicron variant a ‘great reason’ to get booster

https://thehill.com/homenews/583275-nih-director-says-omicron-variant-a-great-reason-to-get-booster

NIH director: "No reason to panic" yet about Omicron variant - Axios

National Institutes of Health (NIH) director Francis Collins said the emergence of a new variant of the coronavirus presents a “great reason” for people in the United States to seek a booster shot. 

“There’s no reason to panic, but it’s a great reason to get boosted,” Collins said Sunday during an appearance on CNN.

The World Health Organization over the weekend held an emergency meeting regarding the new coronavirus strain first identified in South Africa, and classified it as being “of concern,” due to the variant’s large number of mutations and an increased risk of re-infection.

Several nations around the world, including the United States, have limited travel to several south African countries in recent days in an attempt to keep the variant from spreading more rapidly. 

During an earlier appearance on Fox News Sunday, Collins said it may take weeks before world health officials can determine how effective vaccines being used in the United States are against the new variant, which has been dubbed “omicron.” 

“Given that history, we expect that most likely the current vaccines will be sufficient to provide protection,” he said. “And especially the boosters will give that additional layer of protection because there’s something about the booster that causes your immune system to really expand its capacity against all kinds of different spike proteins, even ones it hasn’t seen before.” 

Collins said on CNN that the emergence of the new variant is “another reason” for people who have not received a coronavirus booster shot to do so once they are eligible. 

“The booster basically enlarges the capacity of your immune system to recognize all kinds of spike proteins its never seen,” Collins explained. “This is a great day to go and get boosted or find out how to do so.” 

Fauci says ‘troublesome’ omicron ‘might evade immune protection’

https://thehill.com/homenews/sunday-talk-shows/583276-fauci-says-troublesome-omicron-might-evade-immune-protection?rnd=1638111734

Dr. Fauci Says We Need to Learn to Live With COVID Because 'We're Not Going  to Eradicate' It


President Biden
’s chief medical adviser, Anthony Fauci, on Sunday called the newly discovered omicron variant of COVID-19 “troublesome” and raised concerns that it “might evade immune protection.”

“Right now, what we have is we have the window into the mutations that are in this new variant. And they are troublesome in the fact that there are about 32 or more variants in that very important spike protein of the virus, which is the business end of the virus,” Fauci said during an interview on NBC’s “Meet the Press.” 

“And there are about 10 or more of these mutations that are on that part of the virus — we call it the receptor binding domain — that actually binds to the cells in your nasopharynx and in your lung,” Fauci continued. “In other words, the profile of the mutations strongly suggest that it’s going to have an advantage in transmissibility and that it might evade immune protection that you would get, for example, from a monoclonal antibody or from the convalescent serum after a person’s been infected and possibly even against some of the vaccine-induced antibodies.”

Though Fauci confirmed that the omicron strain has not yet been detected in the U.S., he said on ABC’s “This Week” that it was “inevitable” that it would hit the country.

Fauci’s comments come as scientists are racing to learn more about the variant, which was first found in South Africa.

The director of the National Institutes of Health, Francis Collins, said during an interview on “Fox News Sunday” that it would take several weeks for scientists to better understand whether omicron could evade the protection of the COVID-19 vaccines.

However, Collins said that because the COVID-19 vaccines have been effective against other variants such as delta, there was reason to believe that it also be effective against omicron.

“Given that history, we expect that most likely the current vaccines will be sufficient to provide protection. And especially the boosters will give that additional layer of protection because there’s something about the booster that causes your immune system to really expand its capacity against all kinds of different spike proteins, even ones it hasn’t seen before,” Collins said.

Gottlieb: ‘A pretty good degree of confidence’ people with three doses are protected from omicron

https://thehill.com/policy/healthcare/583280-gottlieb-a-pretty-good-degree-of-confidence-that-people-with-three

Sunday shows - Spotlight shifts to omicron variant | TheHill

Former Food and Drug Administration (FDA) Commissioner Scott Gottlieb on Sunday said vaccine developers have “a pretty good degree of confidence” that fully vaccinated individuals who have received a COVID-19 booster are protected against the omicron variant.

Appearing on CBS’s “Face the Nation,” Gottlieb said that there is no indication that the omicron variant first detected in South Africa makes individuals more ill than other previously detected variants, and that there have been anecdotal accounts of people experiencing mild cases of COVID-19, though he pointed out that initial cases appear to have been clustered among young people.

“The question here is going to be whether or not a fully boosted individual someone who’s had three doses of vaccine has good protection against this variant right now,” said Gottlieb, who now sits on Pfizer’s board of directors.

“If you talk to people in vaccine circles, people who are working on a vaccine, they have a pretty good degree of confidence that a boosted vaccine, so three full doses of vaccine, is going to be fairly protective against this new variant,” said Gottlieb.

However, Gottlieb stressed that data on the omicron data is sparse, with no clinical studies or test tube studies having been completed. He estimated that studies testing the blood of vaccinated people against the omicron variant could be out by the end of this week or some time next week.

“Now, I would expect that those studies are going to show that the neutralization against this virus declined substantially. But that doesn’t mean that the vaccines won’t be effective,” he said.

How to Talk about Vaccines at Thanksgiving

May be an image of 6 people and text that says 'How to talk about vaccines at Thanksgiving The big thing to know when talking to family and friends about vaccine falsehoods during the holidays: It's better to respond with facts than to offer corrections.'

“Please pass the green beans.” “What kind of pie is that?”“What about spike proteins!?”These are some of the phrases that may be uttered during your Thanksgiving and holiday dinners this season. But! We have prepared a glossary for you. Swipe through a quick guide to some of the most misused terms around vaccines that PolitiFact has noticed in our fact-checking. And because we know that shouts of “that’s wrong!” don’t go over smooth like gravy, we’re including an expert’s advice on how to talk about vaccine falsehoods with family and friends.The big thing to know: It’s better to respond with facts than to offer corrections.”If they said something like ‘the vaccine is dangerous,’ include a statistic about how 75% of the people in their state have gotten vaccinated and none have died, or how severe and dangerous COVID-19 is,” said Rupali Limaye, an associate scientist at Johns Hopkins School of Public Health. “And, ultimately, make sure you’re saying it all with empathy.”

May be an image of text that says '"Spike protein" The human body and other organisms are made up of a variety of proteins, and SARS-COV-2, the virus that causes COVID-19, has its own. The virus' spike protein, which allows the virus to penetrate cells and cause infection, has sharp bumps that protrude from the surface of the virus' outer envelopes. COVID-19 vaccines introduce a piece of the protein- but not the harmful part of the virus which the immune system quickly identifies, attacks and destroys as a foreign invader.'
May be an image of text that says '"mRNA" The Pfizer and Moderna COVID-19 vaccines use messenger RNA to deliver an instruction manual to cells for making the coronavirus' spike protein. They're different from conventiona vaccines that use part of a bacterium or virus to induce protein production. The mRNA is fragile and quickly broken down in the body once the cells learn the blueprint, which is usually within three days of receiving the vaccine. The molecule does not we repeat, does not enter the nucleus of cells and alter a person's DNA.'
May be an image of text that says '"VAERS" VAERS stands for the Vaccine Adverse Effects Reporting System, a critical reporting tool for the federal government to collect and analyze data on after-effects from all vaccines, not just COVID-19. Unlike other government data sources, VAERS is designed so that anyone- parents, patients and health care professionals can report health effects that occur after a vaccination, whether or not those effects were caused by the vaccine. The reports aren't verified before they're entered, and anyone with a computer can access the data.'
May be an image of text that says '"Syncytin-1" Syncytin-1, a protein found in humans and some animals, is most known for helping develop the placenta, the temporary organ that helps nourish a fetus during pregnancy. Syncytin-1 and the coronavirus spike protein have almost nothing in common, making the vaccine highly unlikely to trigger a reaction. "If someone says they heard the vaccine causes infertility, would just respond with something direct- like that there are no studies that show a link between the vaccines and infertility Zero," an expert said.'
May be an image of text that says '"Ivermectin" vermectir is an anti-parasitic medication that has been widely touted as a COVID-19 treatment despite health authorities warning against COVID-19 patients self-medicating with the drug. When people started to believe it could treat COVID- 19, some of them ingested forms of the drug made for animals, causing a dramatic uptick in calls to poison control. Officials warn that more research is still needed on ivermectin's effectiveness as a COVID-19 treatment.'
May be an image of text that says 'A final word about words The best way to talk through different views on vaccines with loved ones is by making your point in a personal context that takes the focus off them. "Think of family member they want to protect, so it's not all about them," said Rupali Limaye, an associate scientist at Johns Hopkins School of Public Health." "Like 'Hey, I'm really concerned about grandma and just want to make sure we are doing all we can to protect her. It leaves the pressure off them but they still have some skin in the game."'

Axios-Ipsos poll: Thanksgiving Roulette

https://www.axios.com/axios-ipsos-poll-thanksgiving-covid-7a043049-d25c-4d3a-9bab-2853973f67af.html

Axios-Ipsos poll: Americans are ready to play COVID roulette for  Thanksgiving

Two-in-three Americans will celebrate this Thanksgiving with friends or family outside their immediate households, and about half of those say their gatherings could include unvaccinated people, according to the latest installment of the Axios/Ipsos Coronavirus Index.

Why it matters: Vaccinations and booster shots are giving more people confidence to resume traditions like sitting around a packed table with masks off. But many are doing so with heightened awareness of what they don’t know when it comes to their holiday companions.

  • This year, 31% see a large or moderate risk in seeing friends or family for Thanksgiving — way down from 64% a year ago.
  • People’s assessment of overall risk of returning to their normal pre-COVID lives is also down, with 44% seeing it as a large to moderate risk this year compared with 72% last year.
  • But when Americans are asked how concerned they still feel about the virus, the numbers haven’t diminished all that much: 69% compared with 85% a year ago.

What they’re saying: “We’re just in a holding pattern,” said Cliff Young, president of Ipsos U.S. Public Affairs.

  • “They’re going to Thanksgiving because they have to, they have to see their family and friends, it’s human nature,” Young said. “But Americans are still deploying mitigating strategies.”
  • Ipsos pollster and senior vice president Chris Jackson said the vaccines “have attenuated some of that risk. But there’s a larger sense of anxiety or concern that hasn’t been dealt with.”

By the numbers: 67% of U.S. adults surveyed said they’ll see friends or family outside their households. That’s 73% of Republicans, 70% of independents and 63% of Democrats.

  • 30% of them said the guests will include unvaccinated people, and another 17% said they don’t know whether other guests will be vaccinated or not.
  • 38% said they’ll be with people who don’t regularly wear masks outside the home, while another 21% said they didn’t know if their guests regularly wear masks.
  • 4% said they’ll be seeing people who’ve been exposed to COVID-19 in the last two weeks; another 28% aren’t sure if people at their gatherings have been exposed.

Between the lines: There’s a modest partisan gap around openness to returning to the communal Thanksgiving table — but a gulf around who you’re willing to sit with.

  • 41% of Republicans expect to spend the holiday with someone who’s unvaccinated, compared with 17% of Democrats.
  • When we asked unvaccinated respondents, 56% of those who will celebrate Thanksgiving with friends and family outside the home expect the guests to include other unvaccinated people.

The big picture: This week’s findings show overwhelming support (86%) for every vaccinated American who wants a booster being able to get one. But only about one in four respondents said they knew much about an anti-viral COVID-19 pill awaiting FDA approval.

  • 23% hadn’t heard about the pill at all, and half had heard of it but said they didn’t know much about it.
  • When the unvaccinated were asked whether they’d rather get a shot to prevent the virus, or wait to catch the virus and then take an approved pill to treat it, the pill drew a slight edge (17% versus 12%) and 15% had no preference, while a majority — 53% — said they’d prefer to take neither.
  • That suggests the pill won’t be a silver bullet — and offers more evidence that there is a segment of American society that doesn’t trust science or government to tell them what to do.

Booster strategy could backfire

https://www.axios.com/covid-vaccine-boosters-thanksgiving-5851be4a-79a7-423a-93bb-390d1eb7d4d3.html

Federal officials waited months before making all American adults eligible for a COVID-19 booster shot — meaning millions of Americans may not have the strongest possible protection as they head into holiday travel.

Why it matters: Critics say the confusing process undermined what has now become a critical effort to stave off another wave of the pandemic.

  • Most vaccinated people, even without a booster, still have very strong protection against serious illness or death. But a third shot drastically increases people’s defenses against even mild infections, which could in turn help reduce the virus’ spread.
  • And some vulnerable vaccinated adults are at risk of serious breakthrough cases.

What they’re saying: “We have a consensus. Boosters are very important in maintaining people’s defenses against COVID. We need to get as many people vaccinated and boosted [as possible] as the winter sets in,” David Kessler, the chief science officer of Biden’s COVID response, said in an interview.

Context: Preliminary data released months ago suggested a significant decline in the vaccines’ effectiveness at preventing infection, although they held up well against severe disease.

  • Based on that data, the Biden administration had hoped to begin allowing booster shots in September for any American adult who was at least eight months removed from their second dose.
  • The CDC and the FDA opted instead to only authorize boosters for seniors, people with high-risk medical conditions and people at high risk of infection, before opening them last week to everyone at least six months out from their initial shots.

In the meantime, red and blue states alike decided to ignore the CDC and open up booster eligibility on their own, and breakthrough infections have become increasingly common.

  • Millions of people who weren’t technically eligible for boosters got them anyway, and a large portion of the most vulnerable patients still haven’t gotten one.
  • Where it stands: Only 41% of vaccinated Americans 65 and older have received a booster shot, as have 20% of all vaccinated adults, per the CDC.

“Some of us were there several months ago. Some wanted more data. In the end, there’s a convergence of opinions. It’s the way an open scientific public health process should work,” Kessler said.

Between the lines: The U.S. drug approval process — with its insistence on high-quality data and careful expert reviews — is the world’s gold standard precisely because it moves deliberately. Regulators have been trying this whole time to figure out how to adapt that system to a fast-moving pandemic.

Some federal officials, as well as many outside experts, said there wasn’t enough data to make a broad booster recommendation earlier this fall.

  • Early on, many public health experts also argued that it was unethical to give Americans a third shot while much of the rest of the world awaited their first shots.
  • Israel embraced boosters before the U.S. beginning over the summer, and its emerging data has been key to making the case that boosters are needed and can help bring surges under control. However, experts still don’t know how long the enhanced protection they give will last.

What they’re saying: “Some argued early on that the primary series was good enough and we should conserve doses for the world. What’s emerging is that all people in the world are going to need to be boosted,” a senior administration official said.

  • “Everyone has a different threshold for how much data they need in making a decision,” the official added. “What made this different is that there’s a pandemic underway, and many saw we were heading into a winter surge.”

30% of hospital healthcare workers remained unvaccinated as of September

Dive Brief:

  • Some 30% of U.S. healthcare workers employed at hospitals remained unvaccinated as of Sept. 15, according to an analysis of Centers for Disease Control and Prevention data published Thursday by the Association for Professionals in Infection Control and Epidemiology.
  • The findings include data from 3.3 million healthcare workers at more than 2,000 hospitals, collected between Jan. 20 and Sept. 15.
  • Healthcare personnel working in children’s hospitals had the highest vaccination rates, along with those working in metropolitan counties.

Dive Insight:

The vaccination rate for healthcare workers is roughly in line with that of the general population, though the risk of exposure and transmission can be higher in settings where infected COVID-19 patients are treated, Hannah Reses, CDC epidemiologist and lead author of the analysis, said.

When the shots were initially rolled out, vaccination rates climbed among healthcare workers, rising from 36% to 60% between January and April of 2021, the analysis found. But a major slowdown occurred shortly after.

From April to August, vaccination rates rose just 5%. They then rose 5% again in just one month — from August to September — likely due to the delta variant and more systems implementing their own mandates, the report said.

Researchers also found discrepancies in vaccination rates based on the type of hospitals and their geographic locations.

By September, workers at children’s hospitals had the highest vaccination rates (77%), followed by those at short-term acute care hospitals (70%), long-term care facilities (68.8%), and critical access hospitals (64%).

Among healthcare workers at facilities in metropolitan areas, about 71% were vaccinated by September, compared to 65% of workers at rural facilities.

The findings come as health systems work to comply with new vaccination mandates from the Biden administration.

Healthcare facilities must follow the CMS rule, which stipulates employees must be fully vaccinated by Jan. 4 or risk losing Medicare and Medicaid funding. Unlike the Occupational Safety and Health Administration’s rule that applies to businesses with 100 employees or more but excludes healthcare providers, the CMS rule does not allow for a testing exception.

Both agencies’ rules were met with pushback. The attorneys general of 10 mostly rural states — Missouri, Nebraska, Arkansas, Kansas, Iowa, Wyoming, Alaska, South Dakota, North Dakota and New Hampshire — filed a lawsuit on Oct. 10 against CMS for its rule and said the mandates would exacerbate existing staffing shortages.

“Requiring healthcare workers to get a vaccination or face termination is unconstitutional and unlawful, and could exacerbate healthcare staffing shortages to the point of collapse, especially in Missouri’s rural areas,” the state’s attorney general, Eric Schmitt, said in a statement.

But some regional systems that implemented their own mandates have seen positive results.

After UNC Health and Novant Health in North Carolina required the shots, staff vaccination rates rose to 97% and 99%, respectively, according to a White House report.

Among Novant Health’s 35,000 employees, about 375 were suspended for not complying, and about 200 of those suspended employees did end up getting vaccinated so they could return to work, according to the report.

And some major hospital chains across the country are joining suit with the looming deadline, including HCA with its 183 hospitals and more than 275,000 employees.

The chain is requiring employees be fully vaccinated by the CMS deadline on Jan. 4, a spokesperson said in an email statement.

At the same time, this year’s flu season is difficult to predict, though, “the number of influenza virus detection reported by public health labs has increased in recent weeks,” Reses said.

“The CDC is preparing for flu and COVID to circulate along with other respiratory viruses, and so flu vaccination therefore will be really important to reduce the risk of flu and potentially serious complications, particularly in combination with COVID-19 circulating,” Reses said.