Perceived Hospital Stress, Severe Acute Respiratory Syndrome Coronavirus 2 Activity, and Care Process Temporal Variance During the COVID-19 Pandemic.
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Anesi George L, Andrews Adair, Bai He Julia, Bhatraju Pavan K, Brett-Major David M, Broadhurst M Jana, Campbell Elizabeth Salvagio, Cobb J Perren, Gonzalez Martin, Homami Sonya, Hypes Cameron D, Irwin Amy, Kratochvil Christopher J, Krolikowski Kelsey, Kumar Vishakha K, Landsittel Douglas P, Lee Richard A, Liebler Janice M, Lutrick Karen, Marts Lucian T, Mosier Jarrod M, Mukherjee Vikramjit, Postelnicu Radu, Rodina Valentina, Segal Leopoldo N, Sevransky Jonathan E, Spainhour Christine, Srivastava Avantika, Uyeki Timothy M, Wurfel Mark M, Wyles David, Evans Laura, Severe Acute Respiratory Infection-Preparedness (SARI-PREP) Study Group
Аннотация
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.