• Kelly C Vranas, Sara E Golden, Shannon Nugent, Thomas S Valley, Amanda Schutz, Abhijit Duggal, Kevin P Seitz, Steven Y Chang, Christopher G Slatore, Donald R Sullivan, Catherine L Hough, and Kusum S Mathews.
• Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Oregon Health and Science University, Portland, OR; Division of Pulmonary and Critical Care, Oregon Health and Science University, Portland, OR; Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address: vranas@ohsu.edu.
• Chest. 2022 Aug 1; 162 (2): 331345331-345.

BackgroundThe COVID-19 pandemic has strained health care systems and has resulted in widespread critical care staffing shortages, negatively impacting the quality of care delivered.Research QuestionHow have hospitals' emergency responses to the pandemic influenced the well-being of frontline intensivists, and do any potential strategies exist to improve their well-being and to help preserve the critical care workforce?Study Design And MethodsWe conducted semistructured interviews of intensivists at clusters of tertiary and community hospitals located in six regions across the United States between August and November 2020 using the "four S" framework of acute surge planning (ie, space, staff, stuff, and system) to organize the interview guide. We then used inductive thematic analysis to identify themes describing the influence of hospitals' emergency responses on intensivists' well-being.ResultsThirty-three intensivists from seven tertiary and six community hospitals participated. Intensivists reported experiencing substantial moral distress, particularly because of restricted visitor policies and their perceived negative impacts on patients, families, and staff. Intensivists also frequently reported burnout symptoms as a result of their experiences with patient death, exhaustion over the pandemic's duration, and perceived lack of support from colleagues and hospitals. We identified several potentially modifiable factors perceived to improve morale, including the proactive provision of mental health resources, establishment of formal backup schedules for physicians, and clear actions demonstrating that clinicians are valued by their institutions.InterpretationRestrictive visitation policies contributed to moral distress as reported by intensivists, highlighting the need to reconsider the risks and benefits of these policies. We also identified several interventions as perceived by intensivists that may help to mitigate moral distress and to improve burnout as part of efforts to preserve the critical care workforce.Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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