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Odetola FO, Carlton EF, Dews A, Anspach RR, Evans MC, Howell JD, Keenan H, Kolovos NS, Levin AB, Mendelson J, Ushay HM, Yager PH. A Tale of 8 Cities: Pediatric Critical Care Redeployment to Adult Care During Wave 1 of COVID-19. Hosp Pediatr 2023; 13:822-832. [PMID: 37646091 DOI: 10.1542/hpeds.2023-007187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND Pediatric hospital resources including critical care faculty (intensivists) redeployed to provide care to adults in adult ICUs or repurposed PICUs during wave 1 of the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVES To determine the magnitude of pediatric hospital resource redeployment and the experience of pediatric intensivists who redeployed to provide critical care to adults with COVID-19. METHODS A mixed methods study was conducted at 9 hospitals in 8 United States cities where pediatric resources were redeployed to provide care to critically ill adults with COVID-19. A survey of redeployed pediatric hospital resources and semistructured interviews of 40 redeployed pediatric intensivists were simultaneously conducted. Quantitative data were summarized as median (interquartile range) values. RESULTS At study hospitals, there was expansion in adult ICU beds from a baseline median of 100 (86-107) to 205 (108-250). The median proportion (%) of redeployed faculty (88; 66-100), nurses (46; 10-100), respiratory therapists (48; 18-100), invasive ventilators (72; 0-100), and PICU beds (71; 0-100) was substantial. Though driven by a desire to help, faculty were challenged by unfamiliar ICU settings and culture, lack of knowledge of COVID-19 and fear of contracting it, limited supplies, exhaustion, and restricted family visitation. They recommended deliberate preparedness with interprofessional collaboration and cross-training, and establishment of a robust supply chain infrastructure for future public health emergencies and will redeploy again if asked. CONCLUSIONS Pediatric resource redeployment was substantial and pediatric intensivists faced formidable challenges yet would readily redeploy again.
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Affiliation(s)
- Folafoluwa O Odetola
- Department of Pediatrics, Division of Pediatric Critical Care Medicine
- Child Health Evaluation and Research Center, University of Michigan Health System, Ann Arbor, Michigan
| | - Erin F Carlton
- Department of Pediatrics, Division of Pediatric Critical Care Medicine
- Child Health Evaluation and Research Center, University of Michigan Health System, Ann Arbor, Michigan
| | - Alyssa Dews
- Child Health Evaluation and Research Center, University of Michigan Health System, Ann Arbor, Michigan
| | - Renee R Anspach
- Department of Sociology, University of Michigan, Ann Arbor, Michigan
| | - Melissa C Evans
- Division of Critical Care Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Joy D Howell
- Division of Critical Care Medicine, Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Heather Keenan
- Division of Critical Care Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Nikoleta S Kolovos
- Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Amanda B Levin
- Division of Pediatric Critical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jenny Mendelson
- Division of Critical Care, Department of Pediatrics, College of Medicine, Tucson, Arizona
| | - H Michael Ushay
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Phoebe H Yager
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Rosen A, Carter D, Applebaum JR, Southern WN, Brodie D, Schwartz J, Cornelius T, Shelton RC, Yip NH, Pincus HA, Hwang C, Cooke J, Adelman JS. Critical Care Clinicians' Experiences of Patient Safety During the COVID-19 Pandemic. J Patient Saf 2022; 18:e1219-e1225. [PMID: 35948317 PMCID: PMC9696681 DOI: 10.1097/pts.0000000000001060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE It is unknown how hospital- and systems-level factors have impacted patient safety in the intensive care unit (ICU) during the COVID-19 pandemic. We sought to understand how the pandemic has exacerbated preexisting patient safety issues and created novel patient safety challenges in ICUs in the United States. METHODS We performed a national, multi-institutional, mixed-methods survey of critical care clinicians to elicit experiences related to patient safety during the pandemic. The survey was disseminated via email through the Society of Critical Care Medicine listserv. Data were reported as valid percentages, compared by COVID caseload and peak of the pandemic; free-text responses were analyzed and coded for themes. RESULTS We received 335 survey responses. On general patient safety, 61% felt that conditions were more hazardous when compared with the prepandemic period. Those who took care of mostly COVID-19 patients were more likely to perceive that care was more hazardous (odds ratio, 4.89; 95% CI, 2.49-9.59) compared with those who took care of mostly non-COVID-19 or no COVID-19 patients. In free-text responses, providers identified patient safety risks related to pandemic adaptations, such as ventilator-related lung injury, medication and diagnostic errors, oversedation, oxygen device removal, and falls. CONCLUSIONS Increased COVID-19 case burden was significantly associated with perceptions of a less safe patient care environment by frontline ICU clinicians. Results of the qualitative analysis identified specific patient safety hazards in ICUs across the United States as downstream consequences of hospital and provider strain during periods of the COVID-19 pandemic.
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Affiliation(s)
- Amanda Rosen
- From the Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital
| | - Danielle Carter
- From the Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital
| | - Jo R. Applebaum
- From the Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital
| | - William N. Southern
- Division of Hospital Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York
| | - Joseph Schwartz
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook
- Department of Medicine, Columbia University Irving Medical Center
| | - Talea Cornelius
- Department of Medicine, Columbia University Irving Medical Center
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University
| | - Natalie H. Yip
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York
| | - Harold A. Pincus
- Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University
- New York State Psychiatric Institute
| | - Calvin Hwang
- Department of Medicine, Weill Cornell Medical College, New York
- New York-Presbyterian Hospital Queens, Queens
| | - Joseph Cooke
- Department of Medicine, Weill Cornell Medical College, New York
- New York-Presbyterian Hospital Queens, Queens
| | - Jason S. Adelman
- From the Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital
- Department of Quality and Patient Safety, New York-Presbyterian Hospital, New York, New York
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PAGNUCCI NICOLA, FORNILI MARCO, PRADAL MARILENA, UCCELLI FRANCESCO, BOVONE ALESSANDRA, MEINI MICHELE, SCATENI MONICA, BAGLIETTO LAURA, FORFORI FRANCESCO. Reorganization of Intensive Care Units for the COVID-19 pandemic: effects on nursing sensitive outcomes. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E383-E390. [PMID: 36415295 PMCID: PMC9648556 DOI: 10.15167/2421-4248/jpmh2022.63.3.2557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Since the first months of 2020 COVID-19 patients who were seriously ill due to the development of ARDS, required admission to the intensive care unit to ensure potentially life-saving mechanical ventilation and support for vital functions. To cope with this emergency, an extremely rapid reorganization of premises, services and staff, to dedicate an entire intensive care unit exclusively to SARS-CoV-2 patients and increasing the number of beds was essential. The aim of the study was to evaluate the effects of reorganization of the COVID-19 intensive care unit in terms of nursing sensitive outcomes. METHODS a retrospective observational study was conducted to compare nursing sensitive outcomes between pre-COVID period and COVID period. RESULTS Falls (0.0 and 0.4%, respectively), physical restraint (1.8 and 1.1%, respectively), and pressure ulcers (8.0 and 3.0%, respectively) were similar in the COVID and in the pre-COVID group. After adjusting for gender, age, BMI, and number of comorbidities, the incidence of bloodstream infections was significantly higher in the COVID group than in the pre-COVID group. There were no statistically significant differences in the incidence between the two groups regarding other evaluated outcomes. CONCLUSION The selected nursing sensitive outcomes maintained similar values in the pre-COVID and COVID patient groups. Healthcare-related infections rate must be considered an important alarm signal of quality of nursing care especially in conditions of excessive workload, stress and the presence of less experienced staff increase.
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Affiliation(s)
- NICOLA PAGNUCCI
- University of Pisa, Department of Clinical and Experimental Medicine
| | - MARCO FORNILI
- University of Pisa, Department of Clinical and Experimental Medicine
| | | | | | | | | | | | - LAURA BAGLIETTO
- University of Pisa, Department of Clinical and Experimental Medicine
| | - FRANCESCO FORFORI
- University of Pisa, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine
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Aparicio Betancourt M, Duarte-Díaz A, Vall-Roqué H, Seils L, Orrego C, Perestelo-Pérez L, Barrio-Cortes J, Beca-Martínez MT, Molina Serrano A, Bermejo-Caja CJ, González-González AI. Global Healthcare Needs Related to COVID-19: An Evidence Map of the First Year of the Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10332. [PMID: 36011970 PMCID: PMC9408445 DOI: 10.3390/ijerph191610332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/10/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic has exposed gaps and areas of need in health systems worldwide. This work aims to map the evidence on COVID-19-related healthcare needs of adult patients, their family members, and the professionals involved in their care during the first year of the pandemic. We searched the databases MEDLINE, Embase, and Web of Science. Two reviewers independently screened titles and abstracts and assessed full texts for eligibility. Disagreements were resolved by consensus. Descriptive data were extracted and inductive qualitative content analysis was used to generate codes and derive overarching themes. Thirty-six studies met inclusion criteria, with the majority reporting needs from the perspective of professionals (35/36). Professionals' needs were grouped into three main clusters (basic, occupational, and psycho-socio-emotional needs); patients' needs into four (basic, healthcare, psycho-socio-emotional, and other support needs); and family members' needs into two (psycho-socio-emotional and communication needs). Transversal needs across subgroups were also identified and grouped into three main clusters (public safety, information and communication, and coordination and support needs). This evidence map provides valuable insight on COVID-19-related healthcare needs. More research is needed to assess first-person perspectives of patients and their families, examine whether needs differ by country or region, and evaluate how needs have evolved over time.
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Affiliation(s)
- Mariana Aparicio Betancourt
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
| | - Andrea Duarte-Díaz
- Canary Islands Health Research Institute Foundation (FIISC), 38109 El Rosario, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
| | - Helena Vall-Roqué
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
| | - Laura Seils
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain
| | - Carola Orrego
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
| | - Lilisbeth Perestelo-Pérez
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 El Rosario, Spain
| | - Jaime Barrio-Cortes
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28007 Madrid, Spain
- Fundación para la Investigación e Innovación Biosanitaria en Atención Primaria, 28003 Madrid, Spain
| | | | | | - Carlos Jesús Bermejo-Caja
- Unidad de Apoyo Técnico Dirección Técnica de Sistemas de información, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, 28035 Madrid, Spain
- Departamento de Enfermería. Universidad Autónoma de Madrid, 28034 Madrid, Spain
| | - Ana Isabel González-González
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28007 Madrid, Spain
- Unidad de Innovación y Proyectos Internacionales, Dirección General de Investigación, Docencia y Documentación, Consejería de Sanidad, 28034 Madrid, Spain
- Institute of General Practice, Goethe University, 60323 Frankfurt, Germany
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Gast S, Barroso J, Blanchard FA, Campbell AA, Carter SJ, Clark EV, Hilton R, Branson R, Greenberg S, Kleinpell R. Critical Care Nurses' Experiences of Caring for Patients With COVID-19: Results of a Thematic Analysis. Am J Crit Care 2022; 31:275-282. [PMID: 35425952 DOI: 10.4037/ajcc2022784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The COVID-19 pandemic has challenged health care professionals, especially those working in intensive care units (ICUs). OBJECTIVES To explore critical care nurses' experiences with and perceptions of the COVID-19 pandemic during the early phases of the pandemic. METHODS Data were from national surveys conducted during March and April 2020 to assess ICU providers' perceptions of the initial phases of the pandemic. A total of 831 responses from nurses to open-ended questions were examined by using thematic analysis. The questions assessed potentially limited resources in the ICU, adequacy of staffing, and measures used to reduce the possibility of spreading COVID-19 to family members. RESULTS Overarching themes concerned access to equipment and preventive measures taken to reduce exposure to the virus. These themes included "sheltering the patient when I don't have enough" and "protecting those I love when I am a vector of transmission." Subthemes for the first overarching theme included not having enough personal protective equipment, not enough staff and not enough properly trained staff, and not enough institutional support. Subthemes for the second overarching theme included "isolating myself from everyone I care about" and "isolating everything I touch from everyone I care about." CONCLUSIONS This thematic analysis identified several concerns of ICU nurses related to caring for patients in the initial phases of the COVID-19 pandemic. Ensuring adequate supplies, staffing, and administrative and emotional support are provided to frontline health care providers during the ongoing pandemic remains essential.
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Affiliation(s)
- Sarah Gast
- Sarah Gast is an assistant professor at Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Julie Barroso
- Julie Barroso is a professor at Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Francesca A Blanchard
- Francesca A. Blanchard is a PhD student at Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Amy A Campbell
- Amy A. Campbell is a PhD student at Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Stacey J Carter
- Stacey J. Carter is a PhD student at Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Emma V Clark
- Emma V. Clark is a PhD student at Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Rachel Hilton
- Rachel Hilton is a PhD student, Vanderbilt University School of Nursing, Nashville, Tennessee, and a psychiatric nurse practitioner, Dallas, Texas
| | - Richard Branson
- Richard Branson is a professor emeritus, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Steven Greenberg
- Steven Greenberg is vice chairperson of education, Department of Anesthesiology, Critical Care, and Perioperative Pain Medicine, NorthShore University Health System, and director of Critical Care Services/ECMO medical director, Evanston Hospital, Evanston, Illinois
| | - Ruth Kleinpell
- Ruth Kleinpell is a professor at Vanderbilt University School of Nursing, Nashville, Tennessee
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Lobo SM, Creutzfeldt CJ, Maia IS, Town JA, Amorim E, Kross EK, Çoruh B, Patel PV, Jannotta GE, Lewis A, Greer DM, Curtis JR, Sharma M, Wahlster S. Perceptions of Critical Care Shortages, Resource Use, and Provider Well-being During the COVID-19 Pandemic: A Survey of 1,985 Health Care Providers in Brazil. Chest 2022; 161:1526-1542. [PMID: 35150658 PMCID: PMC8828383 DOI: 10.1016/j.chest.2022.01.057] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/18/2022] [Accepted: 01/31/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Brazil has been disproportionately affected by COVID-19, placing a high burden on ICUs. RESEARCH QUESTION Are perceptions of ICU resource availability associated with end-of-life decisions and burnout among health care providers (HCPs) during COVID-19 surges in Brazil? STUDY DESIGN AND METHODS We electronically administered a survey to multidisciplinary ICU HCPs during two 2-week periods (in June 2020 and March 2021) coinciding with COVID-19 surges. We examined responses across geographical regions and performed multivariate regressions to explore factors associated with reports of: (1) families being allowed less input in decisions about maintaining life-sustaining treatments for patients with COVID-19 and (2) emotional distress and burnout. RESULTS We included 1,985 respondents (57% physicians, 14% nurses, 12% respiratory therapists, 16% other HCPs). More respondents reported shortages during the second surge compared with the first (P < .05 for all comparisons), including lower availability of intensivists (66% vs 42%), ICU nurses (53% vs 36%), ICU beds (68% vs 22%), and ventilators for patients with COVID-19 (80% vs 70%); shortages were highest in the North. One-quarter of HCPs reported that families were allowed less input in decisions about maintaining life-sustaining treatments for patients with COVID-19, which was associated with lack of intensivists (adjusted relative risk [aRR], 1.37; 95% CI, 1.05-1.80) and ICU beds (aRR, 1.71; 95% CI, 1.16-2.62) during the first surge and lack of N95 masks (aRR, 1.43; 95% CI, 1.10-1.85), noninvasive positive pressure ventilation (aRR, 1.56; 95% CI, 1.18-2.07), and oxygen concentrators (aRR, 1.50; 95% CI, 1.13-2.00) during the second surge. Burnout was higher during the second surge (60% vs 71%; P < .001), associated with witnessing colleagues at one's hospital contract COVID-19 during both surges (aRR, 1.55 [95% CI, 1.25-1.93] and 1.31 [95% CI, 1.11-1.55], respectively), as well as worries about finances (aRR, 1.28; 95% CI, 1.02-1.61) and lack of ICU nurses (aRR, 1.25; 95% CI, 1.02-1.53) during the first surge. INTERPRETATION During the COVID-19 pandemic, ICU HCPs in Brazil experienced substantial resource shortages, health care disparities between regions, changes in end-of-life care associated with resource shortages, and high proportions of burnout.
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Affiliation(s)
- Suzana M Lobo
- Intensive Care Department, Hospital de Base, São José do Rio Preto, São Paulo, Brazil; Associação de Medicina Intensiva Brasileira, Florianópolis, Santa Catarina, Brazil
| | - Claire J Creutzfeldt
- Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA; Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA
| | - Israel S Maia
- Department of Intensive Care Medicine, Hospital Nereu Ramos, Florianópolis, Santa Catarina, Brazil
| | - James A Town
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
| | - Edilberto Amorim
- Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Erin K Kross
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
| | - Başak Çoruh
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
| | - Pratik V Patel
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Gemi E Jannotta
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Ariane Lewis
- Departments of Neurology and Neurosurgery, New York University, New York, NY
| | - David M Greer
- Department of Neurology, Boston University, Boston, MA
| | - J Randall Curtis
- Department of Intensive Care Medicine, Hospital Nereu Ramos, Florianópolis, Santa Catarina, Brazil; Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, WA
| | - Sarah Wahlster
- Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA; Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA; Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, WA.
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Mehta S, Yarnell C, Shah S, Dodek P, Parsons-Leigh J, Maunder R, Kayitesi J, Eta-Ndu C, Priestap F, LeBlanc D, Chen J, Honarmand K. The impact of the COVID-19 pandemic on intensive care unit workers: a nationwide survey. Can J Anaesth 2022; 69:472-484. [PMID: 34940952 PMCID: PMC8697539 DOI: 10.1007/s12630-021-02175-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To evaluate the impact of the COVID-19 pandemic on Canadian intensive care unit (ICU) workers. METHODS Between June and August 2020, we distributed a cross-sectional online survey of ICU workers evaluating the impact of the pandemic, coping strategies, symptoms of post-traumatic stress disorder (PTSD; Impact of Events Scale-Revised), and psychological distress, anxiety, and depression (Kessler Psychological Distress Scale). We performed regression analyses to determine the predictors of psychological symptoms. RESULTS We analyzed responses from 455 ICU workers (80% women; 67% from Ontario; 279 nurses, 69 physicians, and 107 other healthcare professionals). Respondents felt that their job put them at great risk of exposure (60%), were concerned about transmitting COVID-19 to family members (76%), felt more stressed at work (67%), and considered leaving their job (37%). Overall, 25% had probable PTSD and 18% had minimal or greater psychological distress. Nurses were more likely to report PTSD symptoms (33%) and psychological distress (23%) than physicians (5% for both) and other health disciplines professionals (19% and 14%). Variables associated with PTSD and psychological distress included female sex (beta-coefficient [B], 1.59; 95% confidence interval [CI], 1.20 to 2.10 and B, 3.79; 95% CI, 1.79 to 5.78, respectively; P < 0.001 for differences in scores across groups) and perceived increased risk due to PPE shortage or inadequate PPE training (B, 1.87; 95% CI, 1.51 to 2.31 and B, 4.88; 95% CI, 3.34 to 6.43, respectively). Coping strategies included talking to friends/family/colleagues (80%), learning about COVID-19 (78%), and physical exercise (68%). Over half endorsed the following workplace strategies as valuable: hospital-provided scrubs, clear communication and protocols by hospitals, knowing their voice is heard, subsidized parking, and gestures of appreciation from leadership. CONCLUSIONS This survey study shows that ICU workers have been impacted by the COVID-19 pandemic with high levels of stress and psychological burden. Respondents endorsed communication, protocols, and appreciation from leadership as helpful mitigating strategies.
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Affiliation(s)
- Sangeeta Mehta
- Department of Medicine, Sinai Health; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
| | - Christopher Yarnell
- Department of Medicine, Sinai Health; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Sumesh Shah
- Department of Medicine, Sinai Health; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter Dodek
- Center for Health Evaluation and Outcome Sciences and Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jeanna Parsons-Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Robert Maunder
- Department of Psychiatry, Sinai Health and University of Toronto, Toronto, ON, Canada
| | | | | | - Fran Priestap
- Department of Surgery, Trauma Program, London Health Sciences Centre, London, ON, Canada
| | - Danielle LeBlanc
- Department of Medicine, Division of Critical Care, Western University, London, ON, Canada
| | - Jennifer Chen
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Kimia Honarmand
- Department of Medicine, Division of Critical Care, Western University, London, ON, Canada
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8
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Lami F, Elfadul M, Rashak H, Al Nsour M, Akhtar H, Khader Y, Hussein AM, Naciri M, Samy S, Ghaleb Y, Taha H, Hussein A, Ali NA, Hussein R, Ikram A, Rahman FU, Khan MM, Adam R, Ahmed AY, Afifi S. Risk Factors of COVID-19 Critical Outcomes in the Eastern Mediterranean Region: Multicountry Retrospective Study. JMIR Public Health Surveill 2022; 8:e32831. [PMID: 34736222 PMCID: PMC8929409 DOI: 10.2196/32831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The establishment of empirical evidence in the Eastern Mediterranean Region necessitates the implementation of wide-scale studies to describe the demographic, clinical features, and severity profile of patients with COVID-19. OBJECTIVE This study aims to assess the patterns of COVID-19 severity and mortality in seven countries, and to determine the risk factors of COVID-19 severity and mortality. METHODS This multicountry study was based on a retrospective review of medical records of hospitalized patients confirmed to have COVID-19. This study includes data from Iraq, Pakistan, Sudan, Somalia, Morocco, Egypt, and Yemen. All demographic and clinical data were extracted from hospital records (paper files) by trained data collectors. RESULTS A total of 4141 patients were included in this study from seven countries. Comorbidities were reported by nearly half of the patients, with hypertension (n=1021, 24.7%) and diabetes (n=939, 22.7%) being the most common. Older age, diabetes mellitus, hypertension, and heart diseases were significantly associated with COVID-19 severity and mortality. Ever smoking and renal diseases were significantly associated with severity but not mortality, while male gender, respiratory diseases, and malignancy were significantly associated with mortality but not severity. CONCLUSIONS The study confirms the role of comorbidities and demographic features on the severity and mortality of COVID-19. Understanding the contributing factors ensures attentive care and informs clinical management of patients with poorer prognoses in the early stages of diseases.
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Affiliation(s)
- Faris Lami
- Department of Community and Family Medicine, University of Baghdad, Baghdad, Iraq
| | - Maisa Elfadul
- Public and Tropical Health Programs, Epidemiology and Biostatistics, University of Medical Sciences and Technology, Khartoum, Sudan
| | - Hiba Rashak
- Ministry of Health, Directorate of Public Health, Baghdad, Iraq
| | - Mohannad Al Nsour
- The Eastern Mediterranean Public Health Network, Global Health Development, Amman, Jordan
| | - Hashaam Akhtar
- Yusra Medical and Dental Collage, Yusra Institute of Pharmaceutical Sciences, Islamabad, Pakistan
| | - Yousef Khader
- Faculty of Medicine, Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Amman, Jordan
| | - Ahmed M Hussein
- Public Health Department, Somali International University, Magadishu, Somalia
| | - Mariam Naciri
- Research Center Biotechnology, Biodiversity and Environment, Laboratory of Biodiversity, Ecology and Genome, Biology Department, Faculty of Sciences, Mohammed V University, Rabat, Morocco
| | - Sahar Samy
- Communicable Disease Control Department - Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Yasser Ghaleb
- Yemen Field Epidemiology Training Program, Ministry of Public Health and Population, Sana'a, Yemen
| | - Hana Taha
- Department of Basic Medical Sciences, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Alaa Hussein
- Public Health Department, Ministry of Health, Babel Health Directorate, Babel, Iraq
| | - Nameer A Ali
- Public Health Department, Ministry of Health, Al-Rusafa Health Directorate, Baghdad, Iraq
| | - Raheem Hussein
- Public Health Department, Ministry of Health, Al-Rusafa Health Directorate, Baghdad, Iraq
| | - Aamer Ikram
- National Institute of Health, Islamabad, Pakistan
| | - Fazal Ur Rahman
- Medical Unit 1 Benazir Bhutto Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Mohammad Mujeeb Khan
- Infectious Diseases Department, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Reema Adam
- Federal Ministry of Health, Directorate of Emergency and Humantarian Actions, Khartoum, Sudan
| | | | - Salma Afifi
- Ministry of Health and Population, Cairo, Egypt
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Use of Social Media to Exchange Critical Care Practice Evidence During the Pandemic. Dimens Crit Care Nurs 2021; 41:36-45. [PMID: 34817960 DOI: 10.1097/dcc.0000000000000499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The evidence-based practice (EBP) process was challenged during the early phase of the COVID-19 pandemic by factors such as a novel disease, rapidly changing guidelines, shortage of personal protective equipment, and other health care supplies. OBJECTIVES Our aims were to (1) explore sources of evidence sought by critical care nurses during a pandemic and (2) explore nurses' perceptions of EBP. METHODS A qualitative exploratory study was conducted using deidentified data from the American Association of Critical-Care Nurses (ACCN) open-access Facebook page, January 28 to April 30, 2020. RESULTS Two major themes were identified: (1) "sharing and seeking evidence," that is, nurses used both formal and informal sources to explore evidence supporting evolving clinical practices, and (2) "concerns about evidence," that is, nurses expressed concerns about lack of evidence and mistrust of evolving evidence. DISCUSSION Initially, there was a mismatch in nurses' expectations of the American Association of Critical-Care Nurses Facebook page. A major limitation of Facebook is the lack of a repository for quick retrieval of information. Despite these limitations, and fear and mistrust of changing guidelines, social media was used to communicate, collaborate, and share evidence to support clinical practice. Critical care nurses seemed to value evidence to support patient management and their personal safety during this evolving health crisis. CONCLUSIONS Social media played a large role in dissemination of timely evidence-based information during the early pandemic. Our results show that current EBP models should be revised to prepare for future crises and include direction for dealing with limited health care resources, and lack of and/or rapidly changing evidence.
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Vranas KC, Golden SE, Mathews KS, Schutz A, Valley TS, Duggal A, Seitz KP, Chang SY, Nugent S, Slatore CG, Sullivan DR, Hough CL. The Influence of the COVID-19 Pandemic on ICU Organization, Care Processes, and Frontline Clinician Experiences: A Qualitative Study. Chest 2021; 160:1714-1728. [PMID: 34062115 PMCID: PMC8164514 DOI: 10.1016/j.chest.2021.05.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in unprecedented adjustments to ICU organization and care processes globally. RESEARCH QUESTIONS Did hospital emergency responses to the COVID-19 pandemic differ depending on hospital setting? Which strategies worked well to mitigate strain as perceived by intensivists? STUDY DESIGN AND METHODS Between August and November 2020, we carried out semistructured interviews of intensivists from tertiary and community hospitals across six regions in the United States that experienced early or large surges of COVID-19 patients, or both. We identified themes of hospital emergency responses using the four S framework of acute surge planning: space, staff, stuff, system. RESULTS Thirty-three intensivists from seven tertiary and six community hospitals participated. Clinicians across both settings believed that canceling elective surgeries was helpful to increase ICU capabilities and that hospitals should establish clearly defined thresholds at which surgeries are limited during future surge events. ICU staff was the most limited resource; staff shortages were improved by the use of tiered staffing models, just-in-time training for non-ICU clinicians, designated treatment teams, and deployment of trainees. Personal protective equipment (PPE) shortages and reuse were widespread, causing substantial distress among clinicians; hands-on PPE training was helpful to reduce clinicians' anxiety. Transparency and involvement of frontline clinicians as stakeholders were important components of effective emergency responses and helped to maintain trust among staff. INTERPRETATION We identified several strategies potentially to mitigate strain as perceived by intensivists working in both tertiary and community hospital settings. Our study also demonstrated the importance of trust and transparency between frontline staff and hospital leadership as key components of effective emergency responses during public health crises.
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Affiliation(s)
- Kelly C Vranas
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR; Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Sara E Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR
| | - Kusum S Mathews
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amanda Schutz
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Thomas S Valley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI
| | - Abhijit Duggal
- Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Kevin P Seitz
- Division of Pulmonary, Allergy, and Critical Care Medicine, Vanderbilt University, Nashville, TN
| | - Steven Y Chang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, Los Angeles, CA
| | - Shannon Nugent
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Department of Psychiatry, Oregon Health & Science University, Portland, OR
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR
| | - Donald R Sullivan
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR; Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Catherine L Hough
- Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR
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11
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Lami F, Elfadul M, Rashak H, Al Nsour M, Akhtar H, Khader Y, Hussein AM, Naciri M, Samy S, Ghaleb Y, Taha H, Hussein A, Ali NA, Hussein R, Ikram A, Rahman FU, Khan MM, Adam R, Ahmed AY, Afifi S. Risk Factors of COVID-19 Critical Outcomes in the Eastern Mediterranean Region: Multicountry Retrospective Study (Preprint).. [DOI: 10.2196/preprints.32831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND
The establishment of empirical evidence in the Eastern Mediterranean Region necessitates the implementation of wide-scale studies to describe the demographic, clinical features, and severity profile of patients with COVID-19.
OBJECTIVE
This study aims to assess the patterns of COVID-19 severity and mortality in seven countries, and to determine the risk factors of COVID-19 severity and mortality.
METHODS
This multicountry study was based on a retrospective review of medical records of hospitalized patients confirmed to have COVID-19. This study includes data from Iraq, Pakistan, Sudan, Somalia, Morocco, Egypt, and Yemen. All demographic and clinical data were extracted from hospital records (paper files) by trained data collectors.
RESULTS
A total of 4141 patients were included in this study from seven countries. Comorbidities were reported by nearly half of the patients, with hypertension (n=1021, 24.7%) and diabetes (n=939, 22.7%) being the most common. Older age, diabetes mellitus, hypertension, and heart diseases were significantly associated with COVID-19 severity and mortality. Ever smoking and renal diseases were significantly associated with severity but not mortality, while male gender, respiratory diseases, and malignancy were significantly associated with mortality but not severity.
CONCLUSIONS
The study confirms the role of comorbidities and demographic features on the severity and mortality of COVID-19. Understanding the contributing factors ensures attentive care and informs clinical management of patients with poorer prognoses in the early stages of diseases.
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Zee-Cheng JE, McCluskey CK, Klein MJ, Scanlon MC, Rotta AT, Shein SL, Pineda JA, Remy KE, Carroll CL. Changes in Pediatric ICU Utilization and Clinical Trends During the Coronavirus Pandemic. Chest 2021; 160:529-537. [PMID: 33727033 PMCID: PMC7954775 DOI: 10.1016/j.chest.2021.03.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Children have been less affected by the COVID-19 pandemic, but its repercussions on pediatric illnesses may have been significant. This study examines the indirect impact of the pandemic on a population of critically ill children in the United States. RESEARCH QUESTION Were there significantly fewer critically ill children admitted to PICUs during the second quarter of 2020, and were there significant changes in the types of diseases admitted? STUDY DESIGN AND METHODS This retrospective observational cohort study used the Virtual Pediatric Systems database. Participants were 160,295 children admitted to the PICU at 77 sites in the United States during quarters 1 (Q1) and 2 (Q2) of 2017 to 2019 (pre-COVID-19) and 2020 (COVID-19). RESULTS The average number of admissions was similar between pre-COVID-19 Q1 and COVID-19 Q1 but decreased by 32% from pre-COVID-19 Q2 to COVID-19 Q2 (20,157 to 13,627 admissions per quarter). The largest decreases were in respiratory conditions, including asthma (1,327 subjects in pre-COVID-19 Q2 (6.6% of patients) vs 241 subjects in COVID-19 Q2 (1.8%; P < .001) and bronchiolitis (1,299 [6.5%] vs 121 [0.9%]; P < .001). The percentage of trauma admissions increased, although the raw number of trauma admissions decreased. Admissions for diabetes mellitus and poisoning/ingestion also increased. In the multivariable model, illness severity-adjusted odds of ICU mortality for PICU patients during COVID-19 Q2 increased compared with pre-COVID-19 Q2 (OR, 1.165; 95% CI, 1.00-1.357; P = .049). INTERPRETATION Pediatric critical illness admissions decreased substantially during the second quarter of 2020, with significant changes in the types of diseases seen in PICUs in the United States. There was an increase in mortality in children admitted to the PICU during this period.
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Affiliation(s)
- Janine E Zee-Cheng
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.
| | - Casey K McCluskey
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV
| | - Margaret J Klein
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Matthew C Scanlon
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Alexandre T Rotta
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Steven L Shein
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Jose A Pineda
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Kenneth E Remy
- Departments of Pediatrics and Internal Medicine, Washington University in St. Louis, St. Louis, MO
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13
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Cag Y, Erdem H, Gormez A, Ankarali H, Hargreaves S, Ferreira-Coimbra J, Rubulotta F, Belliato M, Berger-Estilita J, Pelosi P, Blot S, Lefrant JY, Mardani M, Darazam IA, Cag Y, Rello J. Anxiety among front-line health-care workers supporting patients with COVID-19: A global survey. Gen Hosp Psychiatry 2021; 68:90-96. [PMID: 33418193 PMCID: PMC7749993 DOI: 10.1016/j.genhosppsych.2020.12.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 12/10/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We aimed to explore anxiety status across a broad range of HCWs supporting patients with COVID-19 in different global regions. METHOD This was an international online survey in which participation was on voluntary basis and data were submitted via Google Drive, across a two-week period starting from March 18, 2020. The Beck Anxiety Inventory was used to quantify the level of anxiety. RESULTS 1416 HCWs (70.8% medical doctors, 26.2% nurses) responded to the survey from 75 countries. The distribution of anxiety levels was: normal/minimal (n = 503, 35.5%), low (n = 390, 27.5%); moderate (n = 287, 20.3%), and severe (n = 236, 16.7%). According to multiple generalized linear model, female gender (p = 0.001), occupation (ie, being a nurse dealing directly with patients with COVID-19 [p = 0.017]), being younger (p = 0.001), reporting inadequate knowledge on COVID-19 (p = 0.005), having insufficient personal protective equipment (p = 0.001) and poor access to hand sanitizers or liquid soaps (p = 0.008), coexisting chronic disorders (p = 0.001) and existing mental health problems (p = 0.001), and higher income of countries where HCWs lived (p = 0.048) were significantly associated with increased anxiety. CONCLUSIONS Front-line HCWs, regardless of the levels of COVID-19 transmission in their country, are anxious when they do not feel protected. Our findings suggest that anxiety could be mitigated ensuring sufficient levels of protective personal equipment alongside greater education and information.
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Affiliation(s)
- Yasemin Cag
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey.
| | | | - Aynur Gormez
- Department of Psychiatry, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Handan Ankarali
- Department of Biostatistics and Medical Informatics, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Sally Hargreaves
- Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | | | - Francesca Rubulotta
- Department of Intensive Care Medicine Charing Cross Hospital Imperial College NHS Trust London, United Kingdom
| | - Mirko Belliato
- UOC Anestesia e Rianimazone 1, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Joana Berger-Estilita
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy; San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Stijn Blot
- Department of Internal Medicine & Pediatrics, Faculty of Medicine & Health Science Ghent University, Ghent, Belgium
| | - Jean Yves Lefrant
- Department of Anaesthesia Critical Care Emergency and Pain Medicine, University Hospital of Nimes, Montpellier University, Nimes, France
| | - Masoud Mardani
- Department of Infectious Diseases, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ilad Alavi Darazam
- Department of Infectious Diseases, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yakup Cag
- University of Health Sciences, Department of Pediatrics, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Jordi Rello
- Department of Anaesthesia Critical Care Emergency and Pain Medicine, University Hospital of Nimes, Montpellier University, Nimes, France; Clinical Research and Epidemiology in Pneumonia and Sepsis, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain; Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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14
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Abulebda K, Ahmed RA, Auerbach MA, Bona AM, Falvo LE, Hughes PG, Gross IT, Sarmiento EJ, Barach PR. National preparedness survey of pediatric intensive care units with simulation centers during the coronavirus pandemic. World J Crit Care Med 2020; 9:74-87. [PMID: 33384950 PMCID: PMC7754533 DOI: 10.5492/wjccm.v9.i5.74] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/04/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronavirus disease pandemic caught many pediatric hospitals unprepared and has forced pediatric healthcare systems to scramble as they examine and plan for the optimal allocation of medical resources for the highest priority patients. There is limited data describing pediatric intensive care unit (PICU) preparedness and their health worker protections.
AIM To describe the current coronavirus disease 2019 (COVID-19) preparedness efforts among a set of PICUs within a simulation-based network nationwide.
METHODS A cross-sectional multi-center national survey of PICU medical director(s) from children’s hospitals across the United States. The questionnaire was developed and reviewed by physicians with expertise in pediatric critical care, disaster readiness, human factors, and survey development. Thirty-five children’s hospitals were identified for recruitment through a long-established national research network. The questions focused on six themes: (1) PICU and medical director demographics; (2) Pediatric patient flow during the pandemic; (3) Changes to the staffing models related to the pandemic; (4) Use of personal protective equipment (PPE); (5) Changes in clinical practice and innovations; and (6) Current modalities of training including simulation.
RESULTS We report on survey responses from 22 of 35 PICUs (63%). The majority of PICUs were located within children’s hospitals (87%). All PICUs cared for pediatric patients with COVID-19 at the time of the survey. The majority of PICUs (83.4%) witnessed decreases in non-COVID-19 patients, 43% had COVID-19 dedicated units, and 74.6% pivoted to accept adult COVID-19 patients. All PICUs implemented changes to their staffing models with the most common changes being changes in COVID-19 patient room assignment in 50% of surveyed PICUs and introducing remote patient monitoring in 36% of the PICU units. Ninety-five percent of PICUs conducted training for donning and doffing of enhanced PPE. Even 6 months into the pandemic, one-third of PICUs across the United States reported shortages in PPE. The most common training formats for PPE were hands-on training (73%) and video-based content (82%). The most common concerns related to COVID-19 practice were changes in clinical protocols and guidelines (50%). The majority of PICUs implemented significant changes in their airway management (82%) and cardiac arrest management protocols in COVID-19 patients (68%). Simulation-based training was the most commonly utilized training modality (82%), whereas team training (73%) and team dynamics (77%) were the most common training objectives.
CONCLUSIONS A substantial proportion of surveyed PICUs reported on large changes in their preparedness and training efforts before and during the pandemic. PICUs implemented broad strategies including modifications to staffing, PPE usage, workflow, and clinical practice, while using simulation as the preferred training modality. Further research is needed to advance the level of preparedness, support staff assuredness, and support deep learning about which preparedness actions were effective and what lessons are needed to improve PICU care and staff protection for the next COVID-19 patient waves.
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Affiliation(s)
- Kamal Abulebda
- Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN 46202, United States
| | - Rami A Ahmed
- Department of Emergency Medicine, School of Medicine, Indiana University, Indianapolis, IN 46202, United States
| | - Marc A Auerbach
- Department of Pediatrics, Division of Pediatrics Emergency Medicine, Yale University School of Medicine, New Haven, CT 06504, United States
| | - Anna M Bona
- Department of Emergency Medicine, School of Medicine, Indiana University, Indianapolis, IN 46202, United States
| | - Lauren E Falvo
- Department of Emergency Medicine, School of Medicine, Indiana University, Indianapolis, IN 46202, United States
| | - Patrick G Hughes
- Department of Integrated Medical Science, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Isabel T Gross
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT 06504, United States
| | - Elisa J Sarmiento
- Department of Emergency Medicine, School of Medicine, Indiana University, Indianapolis, IN 46202, United States
| | - Paul R Barach
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48202, Jefferson College of Population Health, Philadelphia, PA, 19107, United States
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15
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Long-Term Acute Care Hospitals Extend ICU Capacity for COVID-19 Response and Recovery. Chest 2020; 159:1894-1901. [PMID: 33309523 PMCID: PMC7832791 DOI: 10.1016/j.chest.2020.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/23/2020] [Accepted: 12/03/2020] [Indexed: 11/21/2022] Open
Abstract
The COVID-19 pandemic has presented novel challenges for the entire health-care continuum, requiring transformative changes to hospital and post-acute care, including clinical, administrative, and physical modifications to current standards of operations. Innovative use and adaptation of long-term acute care hospitals (LTACHs) can safely and effectively care for patients during the ongoing COVID-19 pandemic. A framework for the rapid changes, including increasing collaboration with external health-care organizations, creating new methods for enhanced communication, and modifying processes focused on patient safety and clinical outcomes, is described for a network of 94 LTACHs. When managed and modified correctly, LTACHs can play a vital role in managing the national health-care pandemic crisis.
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16
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Kleinpell R, Ferraro DM, Maves RC, Kane Gill SL, Branson R, Greenberg S, Doersam JK, Raman R, Kaplan LJ. Coronavirus Disease 2019 Pandemic Measures: Reports From a National Survey of 9,120 ICU Clinicians. Crit Care Med 2020; 48:e846-e855. [PMID: 32639413 PMCID: PMC7340128 DOI: 10.1097/ccm.0000000000004521] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
IMPORTANCE Recent reports identify that among hospitalized coronavirus disease 2019 patients, 30% require ICU care. Understanding ICU resource needs remains an essential component of meeting current and projected needs of critically ill coronavirus disease 2019 patients. OBJECTIVES This study queried U.S. ICU clinician perspectives on challenging aspects of care in managing coronavirus disease 2019 patients, current and anticipated resource demands, and personal stress. DESIGN, SETTING, AND PARTICIPANTS Using a descriptive survey methodology, an anonymous web-based survey was administered from April 7, 2020, to April 22, 2020 (email and newsletter) to query members of U.S. national critical care organizations. MEASUREMENTS AND MAIN RESULTS Through a 16-item descriptive questionnaire, ICU clinician perceptions were assessed regarding current and emerging critical ICU needs in managing the severe acute respiratory syndrome coronavirus 2 infected patients, resource levels, concerns about being exposed to severe acute respiratory syndrome coronavirus 2, and perceived level of personal stress. A total of 9,120 ICU clinicians responded to the survey, representing all 50 U.S. states, with 4,106 (56.9%) working in states with 20,000 or more coronavirus disease 2019 cases. The 7,317 respondents who indicated their profession included ICU nurses (n = 6,731, 91.3%), advanced practice providers (nurse practitioners and physician assistants; n = 334, 4.5%), physicians (n = 212, 2.9%), respiratory therapists (n = 31, 0.4%), and pharmacists (n = 30, 0.4%). A majority (n = 6,510, 88%) reported having cared for a patient with presumed or confirmed coronavirus disease 2019. The most critical ICU needs identified were personal protective equipment, specifically N95 respirator availability, and ICU staffing. Minimizing healthcare worker virus exposure during care was believed to be the most challenging aspect of coronavirus disease 2019 patient care (n = 2,323, 30.9%). Nurses report a high level of concern about exposing family members to severe acute respiratory syndrome coronavirus 2 (median score of 10 on 0-10 scale). Similarly, the level of concern reached the maximum score of 10 in ICU clinicians who had provided care to coronavirus disease 2019 patients. CONCLUSIONS This national ICU clinician survey identifies continued concerns regarding personal protective equipment supplies with the chief issue being N95 respirator availability. As the pandemic continues, ICU clinicians anticipate a number of limited resources that may impact ICU care including personnel, capacity, and surge potential, as well as staff and subsequent family members exposure to severe acute respiratory syndrome coronavirus 2. These persistent concerns greatly magnify personal stress, offering a therapeutic target for professional organization and facility intervention efforts.
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Affiliation(s)
- Ruth Kleinpell
- Center for Research & Scholarship Development, Vanderbilt University School of Nursing, Nashville, TN
| | - David M Ferraro
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO
| | - Ryan C Maves
- Department of Critical Care Medicine, Naval Medical Center, San Diego, CA
| | | | - Richard Branson
- Division of Trauma & Critical Care, University of Cincinnati, Cincinnati, OH
| | - Steven Greenberg
- Department of Anesthesiology & Critical Care Services, Evanston Hospital, NorthShore University HealthSystem, Evanston, IL
| | - Jennifer K Doersam
- Center for Research & Scholarship Development, Vanderbilt University School of Nursing, Nashville, TN
| | - Rameela Raman
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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17
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Wahlster S, Sharma M, Lewis AK, Patel PV, Hartog CS, Jannotta G, Blissitt P, Kross EK, Kassebaum NJ, Greer DM, Curtis JR, Creutzfeldt CJ. The Coronavirus Disease 2019 Pandemic's Effect on Critical Care Resources and Health-Care Providers: A Global Survey. Chest 2020; 159:619-633. [PMID: 32926870 PMCID: PMC7484703 DOI: 10.1016/j.chest.2020.09.070] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/28/2020] [Accepted: 09/07/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has severely affected ICUs and critical care health-care providers (HCPs) worldwide. RESEARCH QUESTION How do regional differences and perceived lack of ICU resources affect critical care resource use and the well-being of HCPs? STUDY DESIGN AND METHODS Between April 23 and May 7, 2020, we electronically administered a 41-question survey to interdisciplinary HCPs caring for patients critically ill with COVID-19. The survey was distributed via critical care societies, research networks, personal contacts, and social media portals. Responses were tabulated according to World Bank region. We performed multivariate log-binomial regression to assess factors associated with three main outcomes: limiting mechanical ventilation (MV), changes in CPR practices, and emotional distress and burnout. RESULTS We included 2,700 respondents from 77 countries, including physicians (41%), nurses (40%), respiratory therapists (11%), and advanced practice providers (8%). The reported lack of ICU nurses was higher than that of intensivists (32% vs 15%). Limiting MV for patients with COVID-19 was reported by 16% of respondents, was lowest in North America (10%), and was associated with reduced ventilator availability (absolute risk reduction [ARR], 2.10; 95% CI, 1.61-2.74). Overall, 66% of respondents reported changes in CPR practices. Emotional distress or burnout was high across regions (52%, highest in North America) and associated with being female (mechanical ventilation, 1.16; 95% CI, 1.01-1.33), being a nurse (ARR, 1.31; 95% CI, 1.13-1.53), reporting a shortage of ICU nurses (ARR, 1.18; 95% CI, 1.05-1.33), reporting a shortage of powered air-purifying respirators (ARR, 1.30; 95% CI, 1.09-1.55), and experiencing poor communication from supervisors (ARR, 1.30; 95% CI, 1.16-1.46). INTERPRETATION Our findings demonstrate variability in ICU resource availability and use worldwide. The high prevalence of provider burnout and its association with reported insufficient resources and poor communication from supervisors suggest a need for targeted interventions to support HCPs on the front lines.
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Affiliation(s)
- Sarah Wahlster
- Department of Neurology, Harborview Medical Center, University of Washington, WA; Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, WA; Department of Neurological Surgery, Harborview Medical Center, University of Washington, WA.
| | - Monisha Sharma
- Department of Global Health, University of Washington, WA
| | - Ariane K Lewis
- Departments of Neurology and Neurosurgery, New York University, NY
| | - Pratik V Patel
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, WA
| | - Christiane S Hartog
- Klinik für Anaesthesie und operative Intensivmedizin, Charité Universitaetsmedizin Berlin, Berlin; Klinik Bavaria Kreischa, Germany
| | - Gemi Jannotta
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, WA
| | - Patricia Blissitt
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, WA
| | - Erin K Kross
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, WA; Cambia Palliative Care Center of Excellence, University of Washington, WA
| | - Nicholas J Kassebaum
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, WA; Department of Global Health, University of Washington, WA
| | - David M Greer
- Department of Neurology, Boston University, Boston, MA
| | - J Randall Curtis
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, WA; Cambia Palliative Care Center of Excellence, University of Washington, WA; Cambia Health Foundation
| | - Claire J Creutzfeldt
- Department of Neurology, Harborview Medical Center, University of Washington, WA; Cambia Palliative Care Center of Excellence, University of Washington, WA; Cambia Health Foundation
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