Coronavirus Disease 2019 Pandemic Measures: Reports From a National Survey of 9,120 ICU Clinicians

Abstract

Importance: Recent reports identify that among hospitalized coronavirus disease 2019 patients, 30% require ICU care. Understanding ICU resource needs remains an essential component of meeting current and projected needs of critically ill coronavirus disease 2019 patients. Objectives: This study queried U.S. ICU clinician perspectives on challenging aspects of care in managing coronavirus disease 2019 patients, current and anticipated resource demands, and personal stress. Design, Setting, and Participants: Using a descriptive survey methodology, an anonymous web-based survey was administered from April 7, 2020, to April 22, 2020 (email and newsletter) to query members of U.S. national critical care organizations. Measurements and Main Results: Through a 16-item descriptive questionnaire, ICU clinician perceptions were assessed regarding current and emerging critical ICU needs in managing the severe acute respiratory syndrome coronavirus 2 infected patients, resource levels, concerns about being exposed to severe acute respiratory syndrome coronavirus 2, and perceived level of personal stress. A total of 9,120 ICU clinicians responded to the survey, representing all 50 U.S. states, with 4,106 (56.9%) working in states with 20,000 or more coronavirus disease 2019 cases. The 7,317 respondents who indicated their profession included ICU nurses (n = 6,731, 91.3%), advanced practice providers (nurse practitioners and physician assistants; n = 334, 4.5%), physicians (n = 212, 2.9%), respiratory therapists (n = 31, 0.4%), and pharmacists (n = 30, 0.4%). A majority (n = 6,510, 88%) reported having cared for a patient with presumed or confirmed coronavirus disease 2019. The most critical ICU needs identified were personal protective equipment, specifically N95 respirator availability, and ICU staffing. Minimizing healthcare worker virus exposure during care was believed to be the most challenging aspect of coronavirus disease 2019 patient care (n = 2,323, 30.9%). Nurses report a high level of concern about exposing family members to severe acute respiratory syndrome coronavirus 2 (median score of 10 on 0-10 scale). Similarly, the level of concern reached the maximum score of 10 in ICU clinicians who had provided care to coronavirus disease 2019 patients. Conclusions: This national ICU clinician survey identifies continued concerns regarding personal protective equipment supplies with the chief issue being N95 respirator availability. As the pandemic continues, ICU clinicians anticipate a number of limited resources that may impact ICU care including personnel, capacity, and surge potential, as well as staff and subsequent family members exposure to severe acute respiratory syndrome coronavirus 2. These persistent concerns greatly magnify personal stress, offering a therapeutic target for professional organization and facility intervention efforts.

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“…ICU clinicians are obliged to wear personal protective equipment (PPE), including gloves, masks and gowns, due to the possibility of contamination [ 17 ]. Studies have shown the detrimental effects of isolation on patients (depression, anxiety and anger), and demonstrate that healthcare workers spent less time with patients in isolation [ 18 ].…”

JAAM nationwide survey on the response to the first wave of COVID‐19 in Japan. Part II: how did medical institutions overcome the first wave and how should they prepare for the future?

“…6 Among patients who were discharged or died, the mortality rate of COVID-19 in this study was 4.5% of all hospitalized patients and 14% in ICU patients; however, this study is limited as no detailed patient information is available. Most hospitals suffered from lack of medical equipment, similar to other countries 7 . More than half of the flagship hospitals could provide only one N95 mask every 2 or more days.…”

“…A survey of ICU clinicians in the USA reported that shortages of PPE masks for medical staff were the most common issue. 7 The majority of hospitals worked diligently to ensure availability of medical supplies and PPE. After a quantity of the equipment was secured, some hospitals became concerned about the quality of the equipment.…”

Adapting clinical pharmacy staffing models during the COVID‐19 pandemic: Lessons learned and considerations for future disaster planning

“…A survey of over 9000 ICU clinicians showed that both the perceived need for PPE masks (N95 respirators) (n = 2896, 38%) and ICU staffing shortages (n = 1614, 21.2%) exceeded all other resource challenges. All clinicians identified staff safety to minimize personal risk as the most challenging aspect of managing COVID‐19 patients in the ICU (respiratory therapists [45.2%], pharmacists [36.7%], physicians [35.7%], nurses [30.6%], and advanced practice providers [27.8%]) 21 . Pharmacy leadership should consider the potential impact and weigh the risks vs the benefits, including the availability of PPE, if removing pharmacists from in‐person rounding and direct patient care.…”