were awaiting COVID-19 test results. Negative test results were needed for the patients to be accepted for admission or re-admission at post-acute-care facilities and nursing homes. Further, hospitals reported difficulty in getting reimbursed for treating patients in non-traditional spaces because there were no qualifying billing codes when treating patients in these locations. For example, to mitigate COVID-19 spread, one hospital relocated speech, occupational, and physical therapy services off-site. However, the hospital said it was unable to bill for these services because it does not own the building housing the relocated services, or meet billing requirements. Hospitals reported that changing and sometimes inconsistent guidance from Federal, State, and local authorities posed challenges and confused hospitals and the public Hospitals reported that it was sometimes difficult to remain current with CDC guidance when training staff on PPE and safety precautions. To reduce the spread of COVID-19 and prepare staff for patient surges, hospitals reported providing training regarding proper use of PPE, procedures for putting on and taking off PPE, and isolation practices. As new information about the virus becomes available and circumstances on the ground change, the Centers for Disease Control and Prevention (CDC) has changed its guidance over time. However, some hospital administrators expressed that it was challenging to stay up to date with CDC guidance and re-educating staff on changes to the guidance (e.g., who needs PPE, when to remove it, and when to reuse it). Some hospitals reported that the multiple changes in guidance contributed to a greater sense of confusion, fear, and distrust among staff that they could rely on hospital procedures to protect them. Hospitals reported instances of receiving conflicting guidance from different Federal, State, and local authorities. Hospitals reported receiving conflicting guidance on criteria for testing, defining elective procedures to delay, use of PPE, and getting supplies from the national stockpile. For example, on proper use of PPE, one hospital administrator reported that CDC guidelines at that time called for use of an N95 mask for all patients suspected of COVID-19 infections, while at the same time, one State said that using a surgical mask and face shield was sufficient for staff treating patients with COVID-19. The hospital noted “[The inconsistency] makes everyone nervous. It would have been better if there was coordination and consistency in guidance among the different levels of government.” Another administrator said, “It’s difficult when a doctor or nurse shows you legitimate information from legitimate sources and they’re contradictory.” Hospitals also reported concerns that misinformation had proliferated among the public, unnecessarily increasing workload on hospitals at a critical time. Many hospital administrators reported needing to spend time responding to fear, lack of information, and lack of understanding in their public communities, which they attributed to an absence of clear, accurate, and consistent information. These hospitals reported having to dispel misinformation and unrealistic Hospital Experiences Responding to the COVID-19 Pandemic: Results of a National Pulse Survey March 23-27, 2020 OEI-06-20-00300 9 expectations among patients about testing and other issues, as well as having to work to educate the community about proper steps to prevent the spread of COVID-19 and when to seek medical attention versus self-isolating at home. One hospital administrator reported the challenge of taking on a public health advocacy role with mayors and county commissioners to advocate implementing social distancing at beaches, restaurants, and the like to slow the spread of COVID-19, in addition to performing normal duties. Another hospital administrator reported that employers were telling employees they cannot return to work without testing negative and that the hospital was having a difficult time educating employers that only certain people can be tested. One administrator stated: “The misinformation that is out there, and the lack of serious understanding about what we could be facing, is extraordinary. It is not helping the situation at all. We need to take this seriously." Hospitals reported using a range of strategies to maintain or expand their capacity to care for patients and to keep staff safe Hospital strategies often attempted to address multiple challenges. These efforts included broad-scale ideas that involved multiple providers and suppliers across the country, as well as smaller-scale, community-based efforts that rose in some cases from hospital leadership and staff, other public health stakeholders, and the general public. For a more detailed list of operational strategies that hospital administrators shared, see Appendix A. Hospital administrators turned to alternative practices and unconventional sources to secure necessary PPE, equipment, and supplies for their staff In an attempt to get needed equipment and supplies, hospital administrators turned to new, sometimes un-vetted, and non-traditional sources. The lack of PPE caused hospitals to consider new and un-vetted sources for PPE of whose reputability they were sometimes unsure. One hospital reported that in working with new vendors, some ordered items did not show up, were