Critical Care Clinician Reports on Coronavirus Disease 2019: Results From a National Survey of 4,875 ICU Providers

Abstract

Importance: Global cases of coronavirus disease 2019 infection continue to increase, and significant numbers of patients are critically ill, placing an immense burden on ICU resources. Understanding baseline resource needs and surge capacity in the ICU will be essential to meet current and projected healthcare needs. Continued appraisal of the state of readiness for healthcare systems at individual, regional and national levels will be paramount to ensure we are poised to continue the fight against coronavirus disease 2019. Objectives: This study queried U.S. ICU clinician perspectives on ICU preparedness and concerns regarding delivering coronavirus disease 2019 patient care. Design, Setting, and Participants: An anonymous web-based survey administered from March 18, 2020, to March 25, 2020 (email and newsletter) used survey methodology to query members of U.S. national critical care organizations. Main Outcomes and Measures: Through a 12-item descriptive questionnaire, ICU clinicians were assessed regarding preparedness, techniques employed to augment critical care capacity, and concerns related to caring for coronavirus disease 2019 patients. Results: A total of 4,875 ICU clinicians responded to the survey. Respondents included ICU nurses ( n = 3,470, 71.3%), physicians ( n = 664, 13.6%), advanced practice providers (nurse practitioners and physician assistants; n = 334, 6.9%), respiratory therapists ( n = 236, 4.9%), and pharmacists ( n = 79, 1.6%). Over half ( n = 2,552, 52.5%) reported having cared for a presumed or confirmed coronavirus disease 2019 patient. The majority ( n = 4,010, 82.9%) identified that their hospital was employing techniques to augment critical care capacity. However, 64.5% ( n = 3,125) believed that their ICU facility and team were inadequately prepared to treat coronavirus disease 2019 patients. The majority ( n = 4,547, 93.9%) anticipated ICU personal protective equipment shortages based upon their current use profile. The chief reported concerns include ICU resource shortages such as supplies, medications, beds, ICU staffing shortages, and patient surge leading to overcrowding. Conclusions and Relevance: This national ICU clinician survey indicates that hospitals are expanding ICU bed capacity to prepare for coronavirus disease 2019 patient surge. Importantly, amid this preparation, ICU clinicians harbor concerns regarding preparedness, staffing, and common use resources that merit specific education as well as resource allocation and utilization planning.

The Coronavirus Disease 2019 Pandemic’s Effect on Critical Care Resources and Health-Care Providers

“…For example, providers in North America reported higher levels of emotional distress or burnout, despite reporting fewer shortages of resources, and were also more likely to base CPR and other critical decisions on family wishes compared with findings in other world regions. Our results, which underscore the psychological burden on HCPs, complement results in recent reports about provider well-being from China, Italy, and the United States during the pandemic, [18][19][20][21][22] as well as results from studies before the pandemic (3%-50% burnout rates across various types of ICU providers). [23][24][25][26] We found modifiable and nonmodifiable predictors of burnout that may inform targeted interventions to improve provider experiences and protect their mental well-being.…”

Anxiety among front-line health-care workers supporting patients with COVID-19: A global survey

“…Accordingly, our results demonstrated a correlation between higher income levels of the countries HCWs live in and anxiety scores. Interestingly, a study among 4875 ICU healthcare workers in the US revealed that they were more concerned about facility preparation than about their salary or personal benefits [ 26 ].…”

Changes in Pediatric ICU Utilization and Clinical Trends During the Coronavirus Pandemic

“…Since COVID-19 was first detected in the United States in January 2020, more than 500,000 American adults have died of this disease. [1][2][3] Children have been less directly affected by the disease, accounting for < 5% of cases and rarely requiring hospitalization, developing critical illness, or dying of COVID-19. 2,[4][5][6][7][8][9] However, the indirect impact of the COVID-19 pandemic on children's overall health and on the development of critical illness is unclear.…”

“…Psychosocial stressors may have led to an increase in child abuse, intentional ingestions, and suicide attempts. 2 Severe infections, traumatic injuries, perioperative conditions, and acute exacerbations of chronic illnesses such as asthma and diabetes are among the most common causes of admission to a PICU; thus, the epidemiology of pediatric critical illness was likely sensitive to the indirect effects of COVID-19.…”