ABSTRACT
INTRODUCTION: Burnout results from physical and mental exhaustion and affects the intentionality to leave the profession. Unfortunately, burnout scenarios have been quite common among Critical Care Advance Practice Providers (APPs). The calls to action to sustain the critical care workforce were in full force before COVID-19 attacked the world and rapidly turned into a pandemic. Already overburdened and depleted critical care workforce was further exacerbated by overwhelming work demands. Our research was aimed at understanding the influence of COVID-19 on the critical care APPs. METHOD(S): We utilized a cross-sectional REDCap survey to understand the self-perceived extent to which the burnout among critical APPs had changed. A single link to survey was emailed to 2775 SCCM physician assistant and nursing section members. There were 578 responses (response rate 20.8%). After excluding 60 non-APPs responses, our sample size was 518. Survey questions asked about the symptoms of emotional exhaustion, depersonalization, perception of reduced personal accomplishments and intention to leave. RESULT(S): We found an increase in burnout and related dimensions. Emotional exhaustion increased from 28.8%- 69.9%, depersonalization increased from 17.2%-37.6%%, and perception of reduced personal accomplishments increased from 18.1%-38% among our study population. We also asked about the intentions to leave critical care and a total of 513 participants engaged with this question. Twenty-two percent (n=114) of our sample expressed an intention to leave critical care. We also asked about the intention to leave the profession altogether and only 21.8% (n=113) participants responded. A total of 43.3% (n=49) respondents reported the intention to leave the profession altogether within the following 2-5 years. Of those who responded, 22.1% (n=25) intended to leave within 1 year and 25.7% (n=29) intended to leave between 5-10 years while 8.9% (n=10) stated that they intended to stay beyond 10 years. CONCLUSION(S): COVID-19 pandemic exacerbated the burnout and its dimensions among critical care APPs. It is crucial to attend to the trends in burnout and intention to leave and mitigation strategies must be employed to sustain the critical care workforce which is key to planning the future of critical care in the US and globally.
ABSTRACT
INTRODUCTION/HYPOTHESIS: Frailty is recognized as a predictor of complications and poor outcomes in the geriatric patient population. Our aim was to study the prevalence of frailty and outcomes in patients following trauma admission to a critical care unit. We hypothesize the presence of admission frailty will be an independent predictor of higher mortality, increased length of stay, and will progress as a result of traumatic injuries post hospitalization within all age groups older than 24years old. METHODS: A prospective observational study was performed over a 3-month period on trauma patients in a trauma critical care unit. An admission frailty and at 6 weeks post-discharge frailty was determine using the 5-item FRAIL Scale. The study was approved by the Institutional Review Board Ethics Committee. All comparisons were performed at a level of significance of p ≤ 0.05. RESULTS: Of the 110 patients admitted to the Trauma ICU from January to March 2021, 25% were considered frail vs. 20% pre-frail vs. 55% non-frail. Mean age of frailty was 70 years old, the youngest age being 48 years old. Pre-frail patients with a mean age of 58 years old, a minimum age of 31years old. Comparing frail vs. non-frail patients', the frail patients had a higher mortality rate (57.1 vs 42.86% p- 0.16);Covid positivity (80 vs 20%, p- 0.03);ETOH (75 vs 25%, p-0.08);sepsis diagnosis (100% vs 0 p-0.09). No statistical significance in ICU LOS (p-0.16) and injury severity score (p-0.43). Statistical significance was achieved between the groups for HTN (p-< 0.0001) and DM (p-0.03). At 6-week post discharge frailty assessment of 67 patients demonstrated statistical significance between admission and post discharge frailty (p-< 0.0001). 25% of the admitted non-frail patients progress to frail state on post-discharge evaluation. 21% of the admitted non-frail patients progress to a pre-frail state. 19% percent of the admitted pre-frail patients progress to a frail state. CONCLUSIONS: Although statistical significance was not achieved in mortality and LOS, both groups trended in the direction towards significance, calling for a larger randomized control trial. We did, however, demonstrate that trauma admission increases frailty scores in all groups. This trend was most revealing in the non-geriatric group.