expired, or were different than what was ordered. The administrator also stated that the hospital did not have the ability to evaluate the quality of the equipment in a meaningful way. Some facilities stated that they turned to non-traditional sources of medical equipment and supplies to combat supply chain disruptions. For instance, some hospitals considered sources for PPE that they would not normally use—such as online retailers, home supply stores, paint stores, autobody supply shops, and beauty salons. To try to make existing supplies of PPE last, hospitals reported conserving and reusing PPE. Hospital administrators discussed implementing or considering new procedures to conserve PPE, including physically securing PPE to prevent theft or misuse, educating staff on appropriate use and conservation, and limiting PPE use according to patient condition. Other hospitals reported reducing the extent and frequency of patient interaction to reduce PPE burn; this included doing as much for a patient as possible in one interaction, having multiple providers see a patient together, or removing equipment like intravenous pumps from patients’ rooms so that it could be prepped elsewhere without Hospital Experiences Responding to the COVID-19 Pandemic: Results of a National Pulse Survey March 23-27, 2020 OEI-06-20-00300 10 PPE. At one facility, staff tested patients at remote sites to, in part, reduce PPE use. Hospitals indicated that staff performing testing remotely can remain in PPE all day, whereas staff who test inside hospitals typically change PPE frequently when moving from suspected COVID-19 patients to other patients. Another hospital described being in ‘war mode’ and abandoning the typical standard of care by only using N95 masks for certain higher-risk procedures for COVID-19 patients such as aerosolized procedures, which can send the virus into the air and put health care workers at risk. Conservation strategies included reusing PPE, which is typically intended to be single-use. To reuse PPE, some hospitals reported using or exploring ultra-violet (UV) sterilization. Other hospitals reported bypassing some sanitation processes by having staff place industry masks over N95 masks so that the N95 mask could be reused. As one administrator characterized the situation, “We are throwing all of our PPE best practices out the window. That one will come back and bite us. It will take a long time for people to get back to doing best practices.” Hospitals also reported turning to non-medical-grade PPE, which they worry may put staff at risk. Instead of reusing medical-grade equipment, some hospitals reported resorting to non-medical-grade PPE such as construction masks or handmade masks and gowns, but were unsure about the guidelines for how to safely do it. For example, one hospital administrator noted that recommendations were not clear about whether cloth masks were good enough, stating, “But if that’s what we have, that’s what we’re going to have to use.” One hospital reported using 3D printing to manufacturer masks, while another hospital reported that its staff had made 500 face shields out of office supplies. Other hospitals reported using community resources to make ends meet, including accepting homemade cloth gowns from a quilter’s guild, asking volunteers to make masks, and asking for donations on their website. One hospital administrator described a plan for the local distillery to blend 100 liters of the hospital's ultrasound gel with the distillery’s alcohol to produce CDC-compliant hand sanitizer. Hospital strategies also focused on ensuring adequate staffing to treat patients with COVID-19 Hospital administrators reported using strategies aimed at ensuring they had sufficient staff with the needed skills to treat COVID-19 patients where most needed. For example, some administrators shared that their hospitals were training certain medical staff, like anesthesiologists, hospitalists, and nursing staff, to help care for patients on ventilators. Further, hospitals touted partnerships with large health care systems as beneficial because they can deploy medical staff, like nurses, to other hospitals in the health care system that may be experiencing a staff shortage. Hospitals reported providing resources to help reduce employee burden as well as anxiety and stress To ease anxiety and reduce outside burdens on staff that could distract them or prevent them from working, some facilities reported assisting staff to access services such as childcare, laundry pick up and drop off, grocery services, and hotel accommodations to promote separation from elderly family members. Hospitals also reported offering or expanding resources to provide employees with Hospital Experiences Responding to the COVID-19 Pandemic: Results of a National Pulse Survey March 23-27, 2020 OEI-06-20-00300 11 emotional and psychological support. One hospital shared that it recruited external mental health clinicians and engaged its own psychiatry staff to help alleviate anxiety among hospital staff. Some strategies focus on managing patient flow and hospital capacity to receive and treat patients Hospital administrators reported using several strategies to manage patient flow as they respond to their communities’ needs during the COVID-19 pandemic. Strategies included promoting the use of ambulatory care for patients with less severe