Lane Christianne Joy, Bhatnagar Manas, Lutrick Karen, Maves Ryan C, Weiner Debra, Rios Olvera Daisy, Uyeki Timothy M, Cobb J Perren, Brown Joan C
Department of Preventive Medicine, Division of Biostatistics, University of Southern California Keck School of Medicine, Los Angeles, CA.
University of Southern California Keck School of Medicine, Los Angeles, CA.
Crit Care Explor. 2022 Jan 5;4(1):e0606. doi: 10.1097/CCE.0000000000000606. eCollection 2022 Jan.
Demonstrate the feasibility of weekly data collection and analysis of public health emergency (PHE) data. Assess fluctuations in, and challenges of, resource matching and potential effect on patient care for influenza in ICUs.
Multicenter prospective noninterventional study testing effectiveness of leveraging the Discovery Critical Care Research Network Program for Resilience and Emergency Preparedness (Discovery-PREP) in performing PHE research. A 20-question internet survey was developed to prospectively assess ICU influenza-related resource stress. An informatics tool was designed to track responses; data were analyzed within 24 hours of weekly survey completion by the team biostatistician for timely reporting.
Critical care and Emergency Medicine Discovery-PREP network investigators self-selected to participate in the voluntary query.
ICUs of 13 hospitals throughout the United States, 12 academic, and one community.
ICU physicians were electronically surveyed weekly over 17 weeks during the influenza season (January 2018-April 2018). Responses were collected for 48 hours after each email query.
The average weekly response among the sites was 79% (range, 65-100%). Significant stress, defined as alterations in ICU staffing and/or resource allocation, occurred in up to 41% of sites during the national peak of influenza activity. These alterations included changes in staffing, not accepting external patient transfers, and canceling elective surgery. During this same period, up to 17% of the sites indicated that these changes might not have been sufficient to prevent potentially avoidable patient harm.
This novel approach to querying ICU operational stress indicated that almost half of participating sites experienced critical care resource limitations during peak influenza season and required process and/or staffing changes to better balance resources with patient care demands. This weekly national reporting infrastructure could be adapted and expanded to better inform providers, hospital emergency management teams, and government leaders during PHEs.
证明每周收集和分析公共卫生突发事件（PHE）数据的可行性。评估重症监护病房（ICU）中流感资源匹配的波动情况、面临的挑战以及对患者护理的潜在影响。
多中心前瞻性非干预性研究，测试利用发现重症监护研究网络恢复力与应急准备项目（Discovery-PREP）开展PHE研究的有效性。设计了一项包含20个问题的网络调查问卷，以前瞻性评估ICU流感相关资源压力。设计了一个信息学工具来跟踪回复；每周调查完成后24小时内，团队生物统计学家对数据进行分析以便及时报告。
重症监护和急诊医学Discovery-PREP网络的研究人员自行选择参与这项自愿调查。
美国13家医院的ICU，其中12家为学术医院，1家为社区医院。
在流感季节（2018年1月至2018年4月）的17周内，每周对ICU医生进行电子调查。每次电子邮件询问后48小时内收集回复。
各站点的平均每周回复率为79%（范围为65%-100%）。在全国流感活动高峰期，高达41%的站点出现了重大压力，定义为ICU人员配备和/或资源分配的改变。这些改变包括人员配备的变化、不接受外部患者转院以及取消择期手术。在同一时期，高达17%的站点表示这些变化可能不足以防止潜在的可避免的患者伤害。
这种查询ICU运营压力的新方法表明，在流感高峰期，近一半的参与站点经历了重症监护资源限制，需要进行流程和/或人员配备的改变，以更好地平衡资源与患者护理需求。这种每周的全国报告基础设施可以进行调整和扩展，以便在公共卫生突发事件期间为医疗服务提供者、医院应急管理团队和政府领导人提供更充分的信息。
