Burnout symptoms among physicians and nurses before, during and after COVID-19 care

OBJECTIVE

this study evaluated burnout symptoms among physicians and nurses before, during and after COVID-19 care.

METHOD

a cross-sectional comparative study in the Pulmonary Care unit of a tertiary-level public hospital. The Maslach Burnout Inventory was used.

RESULTS

280 surveys were distributed across three periods: before (n=80), during (n=105) and after (n=95) COVID-19 care; 172 surveys were returned. The response rates were 57.5%, 64.8% and 61.1%, respectively. The prevalence of severe burnout was 30.4%, 63.2% and 34.5% before, during and after COVID-19 care (p<0.001). Emotional exhaustion (p<0.001) and depersonalization (p=0.002) symptoms were more prevalent among nurses than among physicians. Severe burnout was more prevalent in women, nurses and night shift staff.

CONCLUSION

the high prevalence of burnout doubled in the first peak of hospital admissions and returned to pre-pandemic levels one month after COVID-19 care ended. Burnout varied by gender, shift and occupation, with nurses among the most vulnerable groups. Focus on early assessment and mitigation strategies are required to support nurses not only during crisis but permanently.

Characteristics and mortality of Mexican patients with COVID-19 and mechanical ventilation

INTRODUCTION

COVID-19-associated mortality in patients who require mechanical ventilation is unknown in the Mexican population.

OBJECTIVE

To describe the characteristics of Mexican patients with COVID-19 who required mechanical ventilation.

METHODS

Observational cohort study carried out in an intensive care unit from March 25 to July 17, 2020. Data were obtained from a prospective database and electronic medical records, and were analyzed with the chi-square test, Fisher's exact test or Mann-Whitney's U-test.

RESULTS

One hundred patients required mechanical ventilation; median age was 56 years, 31 % were females and 97 % were Latin American. Most common comorbidities were obesity (36 %), diabetes (26 %), hypertension (20 %), and chronic or end-stage kidney disease (10 %). At the end of the analysis, 11 patients remained in the ICU, 31 had been discharged alive and 58 (65.2 %) died; survivors were younger, had lower scores on severity and organ dysfunction scales, lower levels of C-reactive protein at ICU admission, were less likely to receive hemodialysis and vasopressors, and had longer hospital and ICU stays.

CONCLUSIONS

This study adds information on the presentation and results of SARS-CoV-2-infected patients who require mechanical ventilation.

Clinical performance and resource utilization in the start of a totally new Intensive Care Unit. Same staff, new area

Background

There is little information of intensive care unit (ICU) performance when it's relocated to a totally new and equipped area.

Objective

To analyze the clinical performance and use of resources of a new respiratory-ICU (nRICU) in a large third-level care hospital.

Method

Cross-sectional, comparative study using prospective data of patients admitted from July 17, 2017 to July 17, 2018. The Rapoport adjusted method was used to obtain the standardized clinical performance index (SCPI) and the standardized resource use index (SRUI).

Results

Out of 354 patients, those who were readmissions or remained hospitalized and those whose treatment was withheld or withdrawn where excluded from the analysis. In 301 patients, the observed survival at hospital discharge was 63% while the expected survival was 67.7%. Values of SCPI and SRUI were -1.03 and 0.05 respectively, placing results in coordinates within two standard deviations when plotted in the Rapoport chart. There was a statistically significant difference in survival when comparing the study period with outcomes obtained in the RICU before its relocation (63% vs. 55%, p = 0.01).

Conclusions

In its 1st year of operation, the nRICU had better clinical performance compared to the former RICU, with no change in the use of resources.

Eventos adversos en una nueva unidad de cuidados intensivos. Influencia del diseño y la tecnología de las instalaciones en las tasas de incidencia

Introduction

New hospitals are replacing old facilities. There is little information on the performance of an intensive care unit (ICU) when it is relocated in a new and equipped area.

Objective

To analyze the impact of the change of ICU facilities from a shared environment to individual beds on the occurrence of adverse events.

Method

Cross-sectional, comparative study, with prospectively collected data from patients admitted from March 01, 2014 to February 28, 2017 to the former ICU (f-ICU) and from July 17, 2017 to January 17, 2019 to the new ICU (n-ICU) of a public teaching hospital. The rate of adverse events was measured in events per 1,000 patient-days.

Results

Among 1,188 patients (f-ICU, n = 681 vs. n-ICU, n = 507), a reduction in the rate of unforeseen cardiac arrest (rate ratio: 0.31; 95% confidence interval [CI] = 0.12-0.80) and an increase in the rate of unplanned extubation (rate ratio: 2.49; 95% CI = 1.24-5.01) were observed, with both being statistically significant. The other nine monitored adverse events showed no changes.

Conclusions

In comparison with the f-ICU, most of the monitored adverse events did not significantly change within the first 18 months of activities at the n-ICU.