• George L Anesi, Adair Andrews, He Julia Bai, Pavan K Bhatraju, David M Brett-Major, M Jana Broadhurst, CampbellElizabeth SalvagioESDepartment of Emergency Medicine, College of Medicine, University of Arizona, Tucson, AZ., J Perren Cobb, Martin Gonzalez, Sonya Homami, Cameron D Hypes, Amy Irwin, Christopher J Kratochvil, Kelsey Krolikowski, Vishakha K Kumar, Douglas P Landsittel, Richard A Lee, Janice M Liebler, Karen Lutrick, Lucian T Marts, Jarrod M Mosier, Vikramjit Mukherjee, Radu Postelnicu, Valentina Rodina, Leopoldo N Segal, Jonathan E Sevransky, Christine Spainhour, Avantika Srivastava, Timothy M Uyeki, Mark M Wurfel, David Wyles, Laura Evans, and Severe Acute Respiratory Infection-Preparedness (SARI-PREP) Study Group.
• Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
• Crit. Care Med. 2023 Apr 1; 51 (4): 445459445-459.

ObjectivesThe COVID-19 pandemic threatened standard hospital operations. We sought to understand how this stress was perceived and manifested within individual hospitals and in relation to local viral activity.DesignProspective weekly hospital stress survey, November 2020-June 2022.SettingSociety of Critical Care Medicine's Discovery Severe Acute Respiratory Infection-Preparedness multicenter cohort study.SubjectsThirteen hospitals across seven U.S. health systems.InterventionsNone.Measurements And Main ResultsWe 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.ConclusionsDuring 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.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.

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