TY - JOUR
T1 - Perceived Hospital Stress, Severe Acute Respiratory Syndrome Coronavirus 2 Activity, and Care Process Temporal Variance during the COVID-19 Pandemic∗
AU - Severe Acute Respiratory Infection-Preparedness (SARI-PREP) Study Group
AU - Anesi, George L.
AU - Andrews, Adair
AU - Bai (Julia), He
AU - Bhatraju, Pavan K.
AU - Brett-Major, David M.
AU - Broadhurst, M. Jana
AU - Campbell, Elizabeth Salvagio
AU - Cobb, J. Perren
AU - Gonzalez, Martin
AU - Homami, Sonya
AU - Hypes, Cameron D.
AU - Irwin, Amy
AU - Kratochvil, Christopher J.
AU - Krolikowski, Kelsey
AU - Kumar, Vishakha K.
AU - Landsittel, Douglas P.
AU - Lee, Richard A.
AU - Liebler, Janice M.
AU - Lutrick, Karen
AU - Marts, Lucian T.
AU - Mosier, Jarrod M.
AU - Mukherjee, Vikramjit
AU - Postelnicu, Radu
AU - Rodina, Valentina
AU - Segal, Leopoldo N.
AU - Sevransky, Jonathan E.
AU - Spainhour, Christine
AU - Srivastava, Avantika
AU - Uyeki, Timothy M.
AU - Wurfel, Mark M.
AU - Wyles, David
AU - Evans, Laura
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/4/1
Y1 - 2023/4/1
N2 - 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.
AB - 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.
KW - COVID-19
KW - capacity strain
KW - hospital stress
KW - severe acute respiratory infection
KW - severe acute respiratory syndrome coronavirus 2
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U2 - 10.1097/CCM.0000000000005802
DO - 10.1097/CCM.0000000000005802
M3 - Article
C2 - 36790189
AN - SCOPUS:85150364448
SN - 0090-3493
VL - 51
SP - 445
EP - 459
JO - Critical care medicine
JF - Critical care medicine
IS - 4
ER -