Influence of Covid-19 on Burnout among Critical Care Advanced Practice Providers

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.

Successful Implementation of a Rural Appalachian Kidney Transplant Program, One Year Outcomes

Purpose: Kidney transplantation has become the optimal treatment for end stage renal disease (ESRD), allowing dialysis free survival. Despite widespread availability of transplant programs;rural patients have limited access to transplantation due to several barriers including increased travel time and financial burden. We report outcomes after establishment of a kidney transplant program serving rural West Virginia. Method(s): A retrospective review of the first 15 kidney transplants performed at a newly established Appalachian transplant program was conducted. Primary outcomes measured were graft survival and function. Other outcomes included graft rejection, patient survival and complications. Data related to patient demographics, etiology of ESRD, type of renal replacement therapy, time on transplant waitlist and average travel to transplant center were also collected. Result(s): The first 15 kidneys transplanted had an overall death censored graft survival rate of 100%. Median patient age was 53 (Range 31- 73 years) and a median follow-up of 6 months (Range 1-13 months). The average time on dialysis for this cohort was 4 years (n=13, Range 1-6 years) and average time on waitlist was 4.06 months (Range 0.4-13.2 months). The most common type of dialysis was hemodialysis (77%) followed by peritoneal dialysis (15%). Two patients were predialysis. Diabetes with hypertension (20%), IgA nephropathy (13%) and diabetes without hypertension (13%) were the most common causes of ESRD. Median graft creatinine was 1.51 mg/dL (Range 1.26 - 1.83 mg/dL) with a glomerular filtration rate (GFR) at 51.38 (Range 41.86-70) at one year. One patient developed acute antibody mediated rejection and one developed borderline T cell mediated rejection (13.3%), which were successfully treated with steroids, plasmapheresis and immune globulin therapy. Two patients died (13.3 %);one from acute respiratory failure following coronavirus (COVID-19) infection and one from cardiac arrest secondary to myocarditis (possible COVID-19). Patients experienced COVID-19 infection at a rate of 13.3 %. The average distance patients had to travel was 94 miles (Range 12 - 164 miles) with a travel time of 1 hour and 52 minutes on average (Range 20 minutes - 2.5 hours) to reach the transplant center. Conclusion(s): We report comparable outcomes from our new rural transplant program despite several barriers to delivery of quality care to our population.

Heart Failure Care Delivery in the COVID19 Era: The Patient's Perspective

Purpose The SARS-CoV-2 outbreak changed healthcare and healthcare delivery around the world. Hospital systems saw a dramatic decline in patient volumes both in the inpatient and outpatient settings. Surveying our center's heart failure (HF) clinic population, we aimed to better understand our patients’ perception of COVID19, their fears, and care delivery preferences in this new era. Methods Consecutive patients with chronic HF presenting to our clinic either in person or virtually were approached to complete a ten question Likert scale survey (Table 1). Acutely decompensated patients and heart transplant recipients were excluded. The survey was anonymous and voluntary. Results 109 patients completed the survey. The average age was 62±14 years, 73 (67%) were male and 64 (59%) had a diagnosis of HF with reduced ejection fraction. Overall, our patients were afraid of contracting COVID19 and getting sicker given their underlying cardiac condition but were not hesitant to call the clinic or come to the emergency department with worsening HF symptoms. Patients responded that virtual appointments are less preferable and less effective than in-person visits. Although the difference did not reach statistical significance, female patients and those with HF with preserved ejection fraction were more concerned. Conclusion Overall, patients with HF are concerned about their increased risk of contracting COVID19. However, they are not likely to avoid healthcare contact and preferred in-person over virtual visits.

Observed Impacts of COVID-19 on Urban CO2 Emissions

Governments restricted mobility and effectively shuttered much of the global economy in response to the COVID-19 pandemic. Six San Francisco Bay Area counties were the first region in the United States to issue a "shelter-in-place" order asking non-essential workers to stay home. Here we use CO2 observations from 35 Berkeley Environment, Air-quality and CO2 Network (BEACO(2)N) nodes and an atmospheric transport model to quantify changes in urban CO2 emissions due to the order. We infer hourly emissions at 900-m spatial resolution for 6 weeks before and 6 weeks during the order. We observe a 30% decrease in anthropogenic CO2 emissions during the order and show that this decrease is primarily due to changes in traffic (-48%) with pronounced changes to daily and weekly cycles;non-traffic emissions show small changes (-8%). These findings provide a glimpse into a future with reduced CO2 emissions through electrification of vehicles.