Multicenter Study

. 2023 Apr 1;51(4):445-459.

doi: 10.1097/CCM.0000000000005802. Epub 2023 Feb 15.

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

George L Anesi¹, Adair Andrews², He Julia Bai³, Pavan K Bhatraju⁴, David M Brett-Major^{3

5}, M Jana Broadhurst^{5

6}, Elizabeth Salvagio Campbell⁷, J Perren Cobb⁸, Martin Gonzalez², Sonya Homami⁴, Cameron D Hypes^{7

9}, Amy Irwin¹⁰, Christopher J Kratochvil⁵, Kelsey Krolikowski¹¹, Vishakha K Kumar², Douglas P Landsittel¹², Richard A Lee¹³, Janice M Liebler¹⁴, Karen Lutrick¹⁵, Lucian T Marts¹⁶, Jarrod M Mosier^{7

9}, Vikramjit Mukherjee¹¹, Radu Postelnicu¹¹, Valentina Rodina¹⁷, Leopoldo N Segal¹¹, Jonathan E Sevransky^{16

18}, Christine Spainhour¹⁸, Avantika Srivastava¹⁹, Timothy M Uyeki²⁰, Mark M Wurfel⁴, David Wyles¹⁰, Laura Evans⁴; Severe Acute Respiratory Infection-Preparedness (SARI-PREP) Study Group

Affiliations

¹ Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
² Society of Critical Care Medicine, Mount Prospect, IL.
³ Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE.
⁴ Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, WA.
⁵ Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE.
⁶ Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center, Omaha, NE.
⁷ Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson, AZ.
⁸ Departments of Surgery and Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
⁹ Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ.
¹⁰ Division of Infectious Diseases, Denver Health Medical Center, Denver, CO.
¹¹ Division of Pulmonary, Critical Care, and Sleep Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY.
¹² Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN.
¹³ Division of Pulmonary Diseases and Critical Care Medicine, University of California, Irvine, School of Medicine, Irvine, CA.
¹⁴ Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
¹⁵ Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ.
¹⁶ Division of Pulmonary, Allergy, Critical Care and Sleep, School of Medicine, Emory University, Atlanta, GA.
¹⁷ Keck School of Medicine, University of Southern California, Los Angeles, CA.
¹⁸ Emory Critical Care Center, Emory Healthcare, Atlanta, GA.
¹⁹ Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
²⁰ Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA.

PMID: 36790189
PMCID: PMC10012837
DOI: 10.1097/CCM.0000000000005802

Free PMC article

Multicenter Study

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

George L Anesi et al. Crit Care Med. 2023.

Free PMC article

. 2023 Apr 1;51(4):445-459.

doi: 10.1097/CCM.0000000000005802. Epub 2023 Feb 15.

Authors

Affiliations

¹ Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
² Society of Critical Care Medicine, Mount Prospect, IL.
³ Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE.
⁴ Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, Seattle, WA.
⁵ Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE.
⁶ Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center, Omaha, NE.
⁷ Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson, AZ.
⁸ Departments of Surgery and Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
⁹ Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ.
¹⁰ Division of Infectious Diseases, Denver Health Medical Center, Denver, CO.
¹¹ Division of Pulmonary, Critical Care, and Sleep Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY.
¹² Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN.
¹³ Division of Pulmonary Diseases and Critical Care Medicine, University of California, Irvine, School of Medicine, Irvine, CA.
¹⁴ Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
¹⁵ Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ.
¹⁶ Division of Pulmonary, Allergy, Critical Care and Sleep, School of Medicine, Emory University, Atlanta, GA.
¹⁷ Keck School of Medicine, University of Southern California, Los Angeles, CA.
¹⁸ Emory Critical Care Center, Emory Healthcare, Atlanta, GA.
¹⁹ Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
²⁰ Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA.

PMID: 36790189
PMCID: PMC10012837
DOI: 10.1097/CCM.0000000000005802

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.

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Conflict of interest statement

Dr. Anesi received funding from the National Institutes of Health (NIH) (K23HL161353), UptoDate, and expert witness consulting. Drs. Anesi and Segal received support for article research from the NIH. Drs. Bhatraju’s, Brett-Major’s, Broadhurst’s, Cobb’s, Kratochvil’s, Kumar’s, Landsittel’s, Lieber’s, Lutrick’s, Sevransky’s, Wurfel’s, Wyles’, and Evans’, and Mr. Gonzalez’s institutions received funding from the Centers for Disease Control and Prevention (CDC) Foundation. Dr. Bhatraju received funding from the NIH (K23DK116967). Drs. Bhatraju, Cobb, Kratochvil, Landsittel, Rodina, Segal, and Evans received support for article research from the CDC Foundation. Dr. Cobb received funding from Akido Labs, BauHealth, and GibLib. Dr. Kumar received funding from Janssen R&D LLC and the Assistant Secretary for Planning and Evaluation Food and Drug Administration. Dr. Liebler received funding from Immunexpress. Dr. Sevransky’s institution received funding from Regeneron Pharmaceuticals, the Department of Health and Human Services, the Department of Defense, and Society of Critical Care Medicine. Dr. Uyeki disclosed government work. Dr. Wyles’ institution received funding from Gilead Sciences. Dr. Evans disclosed that she serves on the Council of the Society of Critical Care Medicine. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Comment in

Surprisingly Few Avoidable Harms From Pandemic Strain in Multihospital U.S. Survey: Resilient Hospitals or Respondent Bias?
Neupane M, Kadri SS. Neupane M, et al. Crit Care Med. 2023 Apr 1;51(4):543-545. doi: 10.1097/CCM.0000000000005810. Epub 2023 Mar 18. Crit Care Med. 2023. PMID: 36928013 No abstract available.

References

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

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

Authors

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Abstract

Conflict of interest statement

Comment in

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