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Publications

Multicenter Study Journal Article Research Support, Non-U.S. Gov't Research Support, N.I.H., Extramural Ppublish 5 citations

PubMed: 36790189 DOI: 10.1097/CCM.0000000000005802

Perceived Hospital Stress, Severe Acute Respiratory Syndrome Coronavirus 2 Activity, and Care Process Temporal Variance During the COVID-19 Pandemic.

Crit Care Med 51(4):445-459

Authors: George L Anesi, Adair Andrews, He Julia Bai, Pavan K Bhatraju, David M Brett-Major, M Jana Broadhurst, Elizabeth Salvagio Campbell, J Perren Cobb, Martin Gonzalez, Sonya Homami, Cameron D Hypes, Amy Irwin, Christopher J Kratochvil, Kelsey Krolikowski, Vishakha K Kumar, Douglas P Landsittel, Richard A Lee, Janice M Liebler, Karen Lutrick, Lucian T Marts, Jarrod M Mosier, Vikramjit Mukherjee, Radu Postelnicu, Valentina Rodina, Leopoldo N Segal, Jonathan E Sevransky, Christine Spainhour, Avantika Srivastava, Timothy M Uyeki, Mark M Wurfel, David Wyles, Laura Evans

Affiliations

  • Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
  • Society of Critical Care Medicine, Mount Prospect, IL.
  • Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE.
  • Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, WA.
  • Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE.
  • Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center, Omaha, NE.
  • Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson, AZ.
  • Departments of Surgery and Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
  • Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ.
  • Division of Infectious Diseases, Denver Health Medical Center, Denver, CO.
  • Division of Pulmonary, Critical Care, and Sleep Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY.
  • Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN.
  • Division of Pulmonary Diseases and Critical Care Medicine, University of California, Irvine, School of Medicine, Irvine, CA.
  • Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
  • Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ.
  • Division of Pulmonary, Allergy, Critical Care and Sleep, School of Medicine, Emory University, Atlanta, GA.
  • Keck School of Medicine, University of Southern California, Los Angeles, CA.
  • Emory Critical Care Center, Emory Healthcare, Atlanta, GA.
  • Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
  • Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA.

Abstract

OBJECTIVES

The COVID-19 pandemic threatened standard hospital operations. We sought to understand how this stress was perceived and manifested within individual hospitals and in relation to local viral activity.

DESIGN

Prospective weekly hospital stress survey, November 2020-June 2022.

SETTING

Society of Critical Care Medicine's Discovery Severe Acute Respiratory Infection-Preparedness multicenter cohort study.

SUBJECTS

Thirteen hospitals across seven U.S. health systems.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We analyzed 839 hospital-weeks of data over 85 pandemic weeks and five viral surges. Perceived overall hospital, ICU, and emergency department (ED) stress due to severe acute respiratory infection patients during the pandemic were reported by a mean of 43% ( sd , 36%), 32% (30%), and 14% (22%) of hospitals per week, respectively, and perceived care deviations in a mean of 36% (33%). Overall hospital stress was highly correlated with ICU stress (ρ = 0.82; p < 0.0001) but only moderately correlated with ED stress (ρ = 0.52; p < 0.0001). A county increase in 10 severe acute respiratory syndrome coronavirus 2 cases per 100,000 residents was associated with an increase in the odds of overall hospital, ICU, and ED stress by 9% (95% CI, 5-12%), 7% (3-10%), and 4% (2-6%), respectively. During the Delta variant surge, overall hospital stress persisted for a median of 11.5 weeks (interquartile range, 9-14 wk) after local case peak. ICU stress had a similar pattern of resolution (median 11 wk [6-14 wk] after local case peak; p = 0.59) while the resolution of ED stress (median 6 wk [5-6 wk] after local case peak; p = 0.003) was earlier. There was a similar but attenuated pattern during the Omicron BA.1 subvariant surge.

CONCLUSIONS

During the COVID-19 pandemic, perceived care deviations were common and potentially avoidable patient harm was rare. Perceived hospital stress persisted for weeks after surges peaked.

MeSH

Infections, Stress, Physiological, Intensive Care Units, Severe Acute Respiratory Syndrome, Coronavirus, Pandemics, Covid-19, Sars-Cov-2

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