Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR; Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR.
Chest. 2021 Nov;160(5):1714-1728. doi: 10.1016/j.chest.2021.05.041. Epub 2021 May 29.
The COVID-19 pandemic resulted in unprecedented adjustments to ICU organization and care processes globally.
Did hospital emergency responses to the COVID-19 pandemic differ depending on hospital setting? Which strategies worked well to mitigate strain as perceived by intensivists?
Between August and November 2020, we carried out semistructured interviews of intensivists from tertiary and community hospitals across six regions in the United States that experienced early or large surges of COVID-19 patients, or both. We identified themes of hospital emergency responses using the four S framework of acute surge planning: space, staff, stuff, system.
Thirty-three intensivists from seven tertiary and six community hospitals participated. Clinicians across both settings believed that canceling elective surgeries was helpful to increase ICU capabilities and that hospitals should establish clearly defined thresholds at which surgeries are limited during future surge events. ICU staff was the most limited resource; staff shortages were improved by the use of tiered staffing models, just-in-time training for non-ICU clinicians, designated treatment teams, and deployment of trainees. Personal protective equipment (PPE) shortages and reuse were widespread, causing substantial distress among clinicians; hands-on PPE training was helpful to reduce clinicians' anxiety. Transparency and involvement of frontline clinicians as stakeholders were important components of effective emergency responses and helped to maintain trust among staff.
We identified several strategies potentially to mitigate strain as perceived by intensivists working in both tertiary and community hospital settings. Our study also demonstrated the importance of trust and transparency between frontline staff and hospital leadership as key components of effective emergency responses during public health crises.
COVID-19 大流行导致全球范围内 ICU 组织和护理流程发生了前所未有的调整。
医院对 COVID-19 大流行的应急反应是否因医院环境而异？哪些策略能有效缓解重症监护医师认为的压力？
在 2020 年 8 月至 11 月期间，我们对来自美国六个地区的三级医院和社区医院的 33 名重症监护医师进行了半结构化访谈，这些地区都经历了 COVID-19 患者的早期或大量涌入，或两者兼有。我们使用急性激增规划的四个 S 框架（空间、人员、物资、系统）来确定医院应急反应的主题。
来自 7 家三级医院和 6 家社区医院的 33 名重症监护医师参与了研究。来自两种环境的临床医生都认为取消择期手术有助于增加 ICU 能力，并且医院应该在未来的激增事件中建立明确界定的手术限制阈值。ICU 工作人员是最有限的资源；通过使用分层人员配备模式、对非 ICU 临床医生进行及时培训、指定治疗团队和部署受训人员，可以改善人员短缺问题。个人防护设备 (PPE) 短缺和再利用普遍存在，给临床医生造成了很大的困扰；PPE 的实际操作培训有助于减轻临床医生的焦虑。透明度和让一线临床医生作为利益相关者参与进来是有效应急反应的重要组成部分，有助于在员工中保持信任。
我们确定了一些策略，可以缓解在三级医院和社区医院工作的重症监护医师所感受到的压力。我们的研究还表明，在公共卫生危机期间，一线工作人员和医院领导层之间的信任和透明度是有效应急反应的关键组成部分。
