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Hospitals Reported Improved Preparedness for Emerging Infectious Diseases After the Ebola Outbreak


The Department of Health and Human Services (HHS) is the lead Federal agency responsible for medical support and coordination during public health emergencies. In 2014, the domestic outbreak of Ebola virus disease (Ebola) tested U.S. hospitals' ability to respond to a serious infectious disease. Very few hospitals received suspected or diagnosed cases of Ebola, but the disease's presence caused hospitals to assess and improve their preparedness for Ebola and other emerging infectious diseases (EIDs). HHS agencies took action to respond to the outbreak, including providing guidance to hospitals and revising requirements for hospital emergency preparedness. This study seeks to assess those efforts by describing the reflections of hospital administrators regarding the outbreak and the actions that hospitals have taken to improve readiness since 2014. This study builds on OIG's body of work in emergency preparedness, which includes a prior study of hospital responses to a natural disaster.


We administered an online survey to a national sample of hospitals in early 2017. We selected a stratified sample of 410 hospitals that participate in Medicare and that have emergency departments. We received responses from 368 of the 410 hospitals (a 90 percent response rate) and projected those findings nationally. The survey included questions about hospital administrators' perceptions of preparedness in 2014 and 2017; actions taken to prepare; and challenges to sustaining preparedness for potential future EIDs. We analyzed some responses by whether hospitals served as Special Pathogen Centers, as designated by ASPR, and/or as Critical Access Hospitals, as designated by CMS.


Most hospitals in the United States were not prepared for the outbreak of Ebola in 2014, with 71 percent of hospital administrators reporting that their facilities were unprepared to receive Ebola patients. By 2017, administrators from only 14 percent of hospitals reported their facilities were still unprepared for EID threats such as Ebola. Hospital actions to improve preparedness included updating emergency plans, training staff to care for patients with EIDs, purchasing additional supplies, and conducting EID-focused drills. Hospitals also used a wide range of resources provided by HHS.

Although most hospital administrators believe that their hospitals are ready to respond to a future EID threat, they cited challenges to maintaining that preparedness, given competing priorities for hospital resources and staff time. Administrators also cited the need to focus efforts on more common hazards, such as natural disasters, and cited difficulty in using government guidance to prepare for EIDs. We also found that administrators from one-third of hospitals did not know their hospital's role in a tiered hospital framework designed by CDC to guide hospitals in receiving and treating cases of Ebola.


A future EID threat could require substantial management and resources by hospitals, other healthcare providers, and government at all levels, including HHS. To improve hospital preparedness and HHS assistance and oversight, we recommend that ASPR, CDC, and CMS continue to support hospital preparedness for potential EIDs by coordinating guidance and providing practical advice for all hospitals. We also recommend that CDC clarify and promote the details and ongoing status of its tiered framework for hospitals, so that hospitals are clear regarding their responsibilities during an EID outbreak. Further, we recommend that CMS add EIDs to the definition of "all hazards" in the State Operations Manual to promote inclusion of EIDs in hospital emergency planning. ASPR, CDC, and CMS concurred with our recommendations.