# Challenges in healthcare facilities’ response to past outbreaks: a systematic review of reviews

## TL;DR

This paper reviews challenges faced by healthcare facilities during past outbreaks in Europe and identifies key areas for improvement in outbreak preparedness.

## Contribution

The study is the first systematic review of reviews to map healthcare facility-level challenges during outbreaks in Europe.

## Key findings

- Key challenges included increased workload, mental health issues, and resource shortages in healthcare facilities.
- Telemedicine and inter-institutional collaboration were identified as both opportunities and challenges during outbreaks.
- A whole-of-society strategy is recommended to strengthen future outbreak preparedness.

## Abstract

The frequency of infectious diseases outbreaks is increasing, but these challenges are not always thoroughly investigated. To date, no systematic reviews of reviews have comprehensively mapped the challenges and gaps faced during past epidemics and pandemics in Europe at healthcare facility level. This systematic review of reviews aims at filling this gap and at contributing to documenting the challenges and informing policy recommendations.

This review was conducted within the Horizon Europe project PREPSHIELD. The search was conducted in October 2024 on PubMed, Scopus, and Web of Science. Reviews published in English between the years 2009–2024, reporting data on COVID-19, H1N1, influenza or seasonal flu, measles, or Mpox, and documenting gaps or challenges in the response to these outbreaks at healthcare facility level were included.

A total of 21 reviews were included: they were systematic, scoping, narrative, rapid, or integrative. The studies included in the reviews were mostly conducted in the United Kingdom, Italy, Spain, and France. The studies included different levels of healthcare facilities, namely hospitals, primary healthcare, and prehospital settings. Findings were classified according to the 4S surge capacity framework and were related to staff (n = 18), stuff (n = 14), space (n = 7), and system (n = 18). The most reported challenges in the included reviews were increased workload, mental health, and task shifting or redeployment, resource shortages, intensive care unit/emergency department space limitations and repurposing, and telemedicine challenges.

Key issues described highlight the need for training, peer-to-peer support mechanisms, and improved inter-institutional collaboration. Technology was described as both an opportunity and a challenge in pandemic response if not adequately supported by health staff training. A whole-of-society strategy, combining all-hazards and hazard-specific approaches, and moving beyond crisis mode, can strengthen future outbreak preparedness and response.

The online version contains supplementary material available at 10.1186/s12913-025-13934-9.