Critically ill patients are often unable to communicate, placing the onus on clinicians in ICUs to engage family members. In the United States, practice has gradually shifted toward including family members in ICU rounds (1). However, the novel coronavirus disease (COVID-19) pandemic dramatically altered hospital care in the United States. For example, early reports suggested many hospitals restricted access to visitors (2). We sought to understand changes to visitation policies and strategies used to communicate with family members because of COVID-19. We identified all hospitals with ICUs in the state of Michigan using the 2018 American Hospital Association annual survey database and by Internet searches. In early April, Michigan's statewide ICU occupancy was 71%, the fifth highest in the United States (3). Within each hospital, an ICU physician or nurse leader from a medical ICU was identified and surveyed over the telephone between April 6, 2020, and May 8, 2020. If the ICU leader was unavailable by telephone, an online survey was conducted. Participants were asked 1) whether their hospital made any changes to its visitation policy; 2) what changes were made; 3) whether their ICU had changed the way it routinely communicated with family members; and 4) what strategies their ICU was using to communicate with family members. x 2 and t tests were used to compare responding and nonresponding hospitals. All tests were two sided, with a P value of less than 0.05 considered significant. This research was deemed to be exempt from review by the University of Michigan Institutional Review Board (HUM00179422). We surveyed 49 out of 89 Michigan hospitals with ICUs (response rate = 55%). Characteristics between responding and nonresponding hospitals were similar (Table 1). All 49 responding hospitals had changes to their visitation policies because of COVID-19 (Figure 1). One hospital (2%) indicated

Objective: The financial burdens and subsequent related distress of medical care, referred to as financial toxicity, may limit access to beneficial treatments. However, financial toxicity after acute care is less described-but may be an important but underexplored mechanism preventing full recovery after critical illnesses such as Acute Respiratory Distress Syndrome (ARDS). We sought to identify the mechanisms by which financial toxicity manifested in patients with ARDS, protective factors against such toxicity, and the consequences of financial toxicity to survivors' lives following ARDS. Design:We conducted semi-structured interviews following patients' hospitalization and during recovery as an ancillary study to a multi-center RCT in ARDS. Patients were 9-16 months post randomization at the time of interview. Setting and participants:The ROSE trial examined the use of early neuromuscular blockade in mechanically ventilated patients with moderate/severe ARDS. We recruited consecutive surviving patients from 29 U.S. sites who were English speaking, consented to follow-up, and were randomized between 11/12/2017 and 4/5/2018 (N=79). Measurements and Main Results:We asked about patients' perceptions of financial burden(s) that they associated with ARDS hospitalization. 46 of 79 (58%) of eligible ARDS survivors participated (from 22 sites); their median age was 56 (IQR 46, 63). 31 of 46 reported at least one ARDS-related financial impact. Financial toxicity manifested via medical bills, changes in insurance coverage, and loss of employment income. Respondents reported not working prior to ARDS, using Medicaid or Medicare, or, conversely, generous work benefits as factors which may have limited financial burdens. Patients reported multiple consequences of ARDS-related Financial Toxicity After ARDS 4 financial toxicity, including harms to their mental and physical health, increased reliance on others, and specific material hardships.Conclusions: Financial toxicity related to critical illness is common and may limit patients' emotional, physical, and social recovery after ARDS hospitalization for at least a year.

BACKGROUND: Patients discharged after COVID-19 report ongoing needs. OBJECTIVES: To measure incident symptoms after COVID-19 hospitalization. DESIGN, SETTING, AND PARTICIPANTS: Preplanned early look at 1-month follow-up surveys from patients hospitalized August 2020 to January 2021 in NHLBI PETAL Network’s Biology and Longitudinal Epidemiology: COVID-19 Observational (BLUE CORAL) study. English- or Spanish-speaking hospitalized adults without substantial pre-COVID-19 disability with a positive molecular test for SARS-CoV-2. RESULTS: Overall, 253 patients were hospitalized for a median of 5 days (interquartile range [IQR], 3-8), and had a median age of 60 years (IQR, 45-68). By race/ethnicity, 136 (53.8%) were non-Hispanic White, 23 (9.1%) were non-Hispanic Black, and 83 (32.8%) were Hispanic. Most (139 [54.9%]) reported a new or worsened cardiopulmonary symptom, and 16% (n = 39) reported new or increased oxygen use; 213 (84.2%) patients reported not feeling fully back to their pre-COVID-19 level of functioning. New limitations in activities of daily living were present in 130 (52.8%) patients. Financial toxicities, including job loss or change (49 [19.8%]), having a loved one take time off (93 [37.8%]), and using up one’s savings (58 [23.2%]), were common. Longer lengths of hospital stay were associated with greater odds of 1-month cardiopulmonary symptoms (adjusted odds ratio [aOR], 1.82 per additional week in the hospital; 95% CI, 1.11-2.98) and new disability (aOR, 2.06; 95% CI, 1.21-3.53). There were not uniform demographic patterns of association. LIMITATIONS: We prioritized patients’ reports of their own incident problems over objective testing. CONCLUSION: Patients who survived COVID-19 in the United States during late 2020/early 2021 still faced new burdens 1 month after hospital discharge.

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OBJECTIVES: Primary care providers (PCPs) receive limited information about their patients’ ICU stays; we sought to understand what additional information PCPs desire to support patients’ recovery following critical illness. DESIGN: Semistructured interviews with PCPs conducted between September 2020 and April 2021. SETTING: Academic health system with central quaternary-care hospital and associated Veterans Affairs medical center. SUBJECTS: Fourteen attending internal medicine or family medicine physicians working in seven clinics across Southeast Michigan (median, 10.5 yr in practice). MAIN OUTCOMES AND MEASURES: We analyzed using a modified Rigorous and Accelerated Data Reduction (RADaR) technique to identify gaps in current discharge summaries for patients with ICU stays, impacts of these gaps, and desired ICU-specific information. We employed RADaR to efficiently consolidate data in Excel Microsoft (Redmond, WA) tables across multiple formats (lists, themes, etc.). RESULTS: PCPs reported receiving limited ICU-specific information in hospital discharge summaries. PCPs often spent significant time reading inpatient records for additional information. Information desired included life-support interventions provided and duration (mechanical ventilation, dialysis, etc.), reasons for treatment decisions (code status changes, medication changes, etc.), and potential complications (delirium, dysphagia, postintensive care syndrome, etc.). Pervasive discharge gaps (ongoing needs, incidental findings, etc.) were described as worse among patients with ICU stays due to more complex illness and required interventions. Insufficient information was felt to lead to incomplete follow-up on critical issues, PCP frustration, and patient harm. PCPs stated that the COVID-19 pandemic exacerbated gaps due to decreased staffing, limited visitation policies, and reliance on telehealth follow-up visits. CONCLUSIONS AND RELEVANCE: Our results identified key data elements sought by PCPs about patients’ ICU stays and suggest opportunities to improve care through developing tools/templates to provide PCPs with ICU-specific information for outpatient follow-up.