George Anesi, MD
Assistant Professor of Medicine, University of Pennsylvania
University of Pennsylvania
Philadelphia, Pennsylvania
Disclosure information not submitted.
Avantika Srivastava, MS
Statistician
University of Pittsburgh, United States
Disclosure information not submitted.
Julia Bai, MPH
PhD Candidate (Epidemiology)
University of Nebraska Medical Center, United States
Disclosure information not submitted.
Adair Andrews, RN, MATD
Staff
Society of Critical Care Medicine, United States
Disclosure information not submitted.
Pavan Bhatraju, MD, MS
Assistant Professor, Pulmonary, Critical Care
University of Washington Medical Center
Seattle
Disclosure information not submitted.
Martin Gonzalez, MS
Staff
Society of Critical Care Medicine, United States
Disclosure information not submitted.
Christopher Kratochvil, MD
Professor
University of Nebraska Medical Center, Nebraska, United States
Disclosure information not submitted.
Vishakha Kumar, MD, MBA
Society of Critical Care Medicine
Mount Prospect, Illinois
Disclosure information not submitted.
Douglas Landsittel, PhD
Professor and Chair of Epidemiology and Biostatistics
Indiana University School of Public Health-Bloomington, United States
Disclosure information not submitted.
Karen Lutrick, PhD
Assistant Professor
University of Arizona, United States
Disclosure information not submitted.
Vikramjit Mukherjee, MD
Assistant Professor
NYU School of Medicine, United States
Disclosure information not submitted.
Radu Postelnicu, MD
Assistant Professor
NYU Grossman School of Medicine, United States
Disclosure information not submitted.
Leopoldo Segal, MD
Assistant Professor
NYU Langone Medical Center and School of Medicine, United States
Disclosure information not submitted.
Jonathan Sevransky, MD, MHS,FCCM
Professor
Emory University Hospital
Atlanta, Georgia
Disclosure information not submitted.
Mark Wurfel, MD, PhD
Professor
University of Washington School of Medicine, United States
Disclosure information not submitted.
J. Perren Cobb, MD, FACS,FCCM
Professor and Clinical Scholar
Keck Medical Center of USC
Los Angeles
Disclosure information not submitted.
David Brett-Major, MD, MPH
Professor
University Of Nebraska Medical Center, United States
Disclosure information not submitted.
Laura Evans, MD, MS, MSc, FCCM
Medical Director of Critical Care
University of Washington Medical Center
Seattle
Disclosure information not submitted.
Title: Hospital Stress and Care Process Temporal Variance During the COVID-19 Pandemic in the U.S.
Introduction: Hospitals experienced substantial stress during the COVID-19 pandemic—threats to standard operations—but it is not well known how this stress manifested at individual hospitals. We aimed to understand patterns of hospital stress over time, where stress was located within hospitals, and correlations between individual stress measures.
Methods: We conducted a weekly hospital stress survey from November 2020 through May 2021 among site leaders from the SCCM Discovery Severe Acute Respiratory Infection – Preparedness (SARI-PREP) multicenter prospective cohort study. The survey assessed hospital stress ordinally and also assessed ED and ICU stress and deviations from standard operating procedures. Pairwise comparisons of strain measures were calculated by Pearson’s correlation coefficients (r).
Results: Eight hospitals across three health systems in New York, California, and Washington contributed 190 hospital-weeks of data. Sites reported unavailability of some hospital resources resulting in potentially avoidable patient harm during 3.5% of hospital-weeks (with at least one such week at four hospitals); alterations in care processes and/or staffing which were fully compensated for during 57.9% of weeks; and no stress during 38.6% of weeks. During one December 2020 week, hospital stress, ICU stress, and care deviations were all present at 100% of reporting sites. The most common care deviations were increased hospital staffing (39.5%) and cancelling elective surgeries (18.6%). Hospital stress and care deviations were highly correlated (r = 0.81, p < 0.0001). Stress was more common in ICUs (72.4%) than EDs (14.3%), and ICU and ED stress were not correlated (r = 0.19, p = 0.05). While ED stress rose and abated earlier, ICU stress and care deviations persisted (range 2–13 weeks longer) as local case rates declined.
Conclusions: Hospital stress during the pandemic varied in degree and type both within and among hospitals over time. Care deviations were common but potentially avoidable patient harm was rare. Systematic national assessments of hospital stress, both during and between pandemics, could inform more rapid, proactive public health responses to novel threats. Areas for further study include impacts from persistent low-level stress and longer-term consequences for hospitals and their communities.