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

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.

Surprisingly Few Avoidable Harms From Pandemic Strain in Multihospital U.S. Survey: Resilient Hospitals or Respondent Bias?*

“…There are four key findings in the study by Anesi et al (13): First, in each pandemic week, four of 10 hospitals, three of 10 ICUs, and one of 10 EDs perceived operational stresses due to COVID-19 patients. Second, the hospital and ICU strain correlated well with each other but less so with ED strain.…”

“…Anesi et al (13) should be commended for further exploring clinicians’ perceptions on hospital strain. Utilizing the Society of Critical Care Medicine’s Discovery-Severe Acute Respiratory Infection-Preparedness network, they administered a longitudinal survey over 85 pandemic weeks (November 2020–June 2022).…”

“…Anesi et al (13) provide a thought-provoking glimpse into the qualitative side of hospital strain and impacts during the pandemic. Whether the study might have…”

“…Anesi et al (13) provide a thought-provoking glimpse into the qualitative side of hospital strain and impacts during the pandemic. Whether the study might have identified centers of resilience, a relatively rosier experience than the rest of the nation or respondent bias ought to be explored further.…”

“…Hence, it is critical to understand whether we can take the findings of the study by Anesi et al (13) at face value and whether it will change thinking in a manner that could drive or suppress action regionally and nationally.…”