The impact of COVID-19 on anaesthesia and critical care services in the UK: a serial service evaluation

Abstract

Between October 2020 and January 2021, we conducted three national surveys to track anaesthetic, surgical and critical care activity during the second COVID-19 pandemic wave in the UK. We surveyed all NHS hospitals where surgery is undertaken. Response rates, by round, were 64%, 56% and 51%. Despite important regional variations, the surveys showed increasing systemic pressure on anaesthetic and peri-operative services due to the need to support critical care pandemic demands. During Rounds 1 and 2, approximately one in eight anaesthetic staff were not available for anaesthetic work. Approximately one in five operating theatres were closed and activity fell in those that were open. Some mitigation was achieved by relocation of surgical activity to other locations. Approximately one-quarter of all surgical activity was lost, with paediatric and non-cancer surgery most impacted. During January 2021, the system was largely overwhelmed. Almost one-third of anaesthesia staff were unavailable, 42% of operating theatres were closed, national surgical activity reduced to less than half, including reduced cancer and emergency surgery. Redeployed anaesthesia staff increased the critical care workforce by 125%. Three-quarters of critical care units were so expanded that planned surgery could not be safely resumed. At all times, the greatest resource limitation was staff. Due to lower response rates from the most pressed regions and hospitals, these results may underestimate the true impact. These findings have important implications for understanding what has happened during the COVID-19 pandemic, planning recovery and building a system that will better respond to future waves or new epidemics.

Keywords: COVID-19; anaesthesia; critical care; peri-operative medicine.

Figure 1

Timing of the surveys and number of hospital admissions due to COVID‐19 in the UK. Grey areas represent the timeline for October 2020 (R1), December 2020 (R2) and January 2021 (R3). Data adapted from [9].

Figure 2

Proportion of respondents (%) that have reported red (not able to resume planned surgery), amber (nearly able to resume planned surgery) or green (able to resume planned surgery) for ‘Space, Staff, Stuff (equipment) and Systems’ categories for R1 (October 2020), R2 (December 2020), R3 (January 2021). ‘Overall hospital status’ indicates the proportion of respondents reporting at least one of staff, space, stuff or systems red (red), no red and at least one amber (amber), all green (green).

Figure 3

Impact on anaesthesia and critical care staffing levels. Total number of anaesthetists and/or intensivists off work or redeployed to ICU activities as a result of COVID‐19 in R1 (October 2020, light blue), R2 (December 2020, mid blue) and R3 (January 2021, dark blue) from responding hospital sites.

Figure 4

Average UK percentage of surgical activity at R1 (October 2020, light blue), R2 (December 2020, mid blue) and R3 (January 2021, dark blue) compared with the corresponding previous year’s activity.

Figure 5

Proportion of operations (%) completed over a 24‐hour period from responding hospital sites compared with the previous year, at R1 (October 2020), R2 (December 2020) and R3 (January 2021). Blue area denotes the proportion (%) of active surgical cases completed and pink area the proportion (%) of lost surgical cases that were completed on the same date the previous year.