The Influence of the COVID-19 Pandemic on ICU Organization, Care Processes, and Frontline Clinician Experiences

Abstract

Background The COVID-19 pandemic resulted in unprecedented adjustments to intensive care unit (ICU) organization and care processes globally. Research Question 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-November 2020, we performed semi-structured interviews of intensivists from tertiary and community hospitals across six regions in the United States (U.S.) that experienced early and/or large surges of COVID-19 patients. We identified themes of hospital emergency responses using the “four S framework” of acute surge planning (i.e., Space, Staff, Stuff, System). Results 33 intensivists from 7 tertiary and 6 community hospitals participated. Clinicians across both settings felt 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 re-use 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 maintain trust among staff. Interpretation We identified several strategies to potentially mitigate strain as perceived by intensivists working in both tertiary and community hospital settings. Our study also demonstrates the importance of trust and transparency between frontline staff and hospital leadership as key components of effective emergency responses during public health crises.

Training and redeployment of healthcare workers to intensive care units (ICUs) during the COVID-19 pandemic: a systematic review

“… 25 26 28 30 Transparency and involvement of frontline clinicians as stakeholders were important components and helped to maintain trust among HCWs. 31 …”

“…2 25 27 28 31 33–37 Another successful strategy was a tiered staffing model where critical care trained physicians or nurses oversaw non-ICU clinicians. 31 This represented an important shift in ways of working and understanding collaborations between health specialists. 3 There were benefits in some specialists taking over ICU roles, examples of this were otolaryngologists examining epistaxis, peritonsillar abscess and facial trauma 22 ; experienced renal physicians, together with trainee radiologists developing line insertion teams or orthopaedists and physiotherapists assisting with proning.…”

Post-Intensive Care Syndrome and Its New Challenges in Coronavirus Disease 2019 (COVID-19) Pandemic: A Review of Recent Advances and Perspectives

“…To overcome many cultural barriers in the ICU, a multidisciplinary team approach is essential. However, the insufficient number of staff is a serious problem during the COVID-19 pandemic [76]. To countermeasure staff shortage and coordinate the multidisciplinary team, staff and resources need to be efficiently and effectively allocated.…”

Perceptions of Critical Care Shortages, Resource Use, and Provider Well-being During the COVID-19 Pandemic

“…14 Regions with limited resources have been underrepresented in prior assessments of ICU resource use and frontline provider experiences. 9,10,15,16 In light of critical medication shortages and ICU bed occupancy levels of > 90% in most states, Brazilian HCPs face challenging decisions about starting or maintaining scarce life-sustaining therapies. Physicians may find themselves having to make such decisions based on available resources and having to limit family input in the shared decision-making process in favor of a more parental approach.…”