A qualitative study of physician perceptions and experiences of caring for critically ill patients in the context of resource strain during the first wave of the COVID-19 pandemic

Jeanna Parsons Leigh,Henry T Stelfox,Josh S Ng-Kamstra,Rebecca Brundin-Mather,Kirsten M Fiest,Laryssa G Kemp,Chloe De Grood

doi:10.1186/s12913-021-06393-5

Jeanna Parsons Leigh, Henry T Stelfox + Show 5 more

Open Access

https://doi.org/10.1186/s12913-021-06393-5

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Abstract

BackgroundThe COVID-19 pandemic has led to global shortages in the resources required to care for critically ill patients and to protect frontline healthcare providers. This study investigated physicians’ perceptions and experiences of caring for critically ill patients in the context of actual or anticipated resource strain during the COVID-19 pandemic, and explored implications for the healthcare workforce and the delivery of patient care.MethodsWe recruited a diverse sample of critical care physicians from 13 Canadian Universities with adult critical care training programs. We conducted semi-structured telephone interviews between March 25–June 25, 2020 and used qualitative thematic analysis to derive primary themes and subthemes.ResultsFifteen participants (eight female, seven male; median age = 40) from 14 different intensive care units described three overarching themes related to physicians’ perceptions and experiences of caring for critically ill patients during the pandemic: 1) Conditions contributing to resource strain (e.g., continuously evolving pandemic conditions); 2) Implications of resource strain on critical care physicians personally (e.g., safety concerns) and professionally (e.g. practice change); and 3) Enablers of resource sufficiency (e.g., adequate human resources).ConclusionsThe COVID-19 pandemic has required health systems and healthcare providers to continuously adapt to rapidly evolving circumstances. Participants’ uncertainty about whether their unit’s planning and resources would be sufficient to ensure the delivery of high quality patient care throughout the pandemic, coupled with fear and anxiety over personal and familial transmission, indicate the need for a unified systemic pandemic response plan for future infectious disease outbreaks.

Highlights

The COVID-19 pandemic has led to global shortages in the resources required to care for critically ill patients and to protect frontline healthcare providers
All but one participant reported that patients with a diagnosis of COVID-19 had been admitted to their Intensive care unit (ICU) at the time of interview
Overarching themes included: 1) Conditions contributing to resource strain, 2) Implications of resource strain on critical care physicians personally and professionally, and 3) Enablers of resource sufficiency (Fig. 1)

Summary

Introduction

The COVID-19 pandemic has led to global shortages in the resources required to care for critically ill patients and to protect frontline healthcare providers. Retrospective studies following the severe acute respiratory syndrome (SARS) outbreak in 2003 have shown that some healthcare providers who worked in locations where contact with SARS patients was common continue to experience symptoms of posttraumatic stress disorder years later [12,13,14] This is especially true in instances where psychological supports were minimal at the time [15]. Executed without adequate personal protective equipment (PPE)— gloves, gowns, eye protection, N95 respirators—may further compromise frontline provider safety [40] It remains unclear how anticipated or actual resource shortages have affected critical care physicians and the delivery of patient care in ICUs in Canada during the pandemic.

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