ABSTRACT
Background: Clinician burnout is a serious problem in healthcare, which could be exacerbated by the consequences of the ongoing global COVID-19 pandemic, including the abrupt shifts in clinical practice (e.g., rapid increase in telehealth services). It is within this context that we conducted a survey of clinicians at a safety-net pediatric hospital to understand how these factors may have affected providers' experiences with and perceptions of burnout. Methods: The brief structured questionnaire was designed by a multidisciplinary team and was sent to all 378 providers at CHOC Children's in June 2020. Questions included demographics, experiences with and perceptions of burnout, and factors that may contribute to or mitigate burnout. After performing descriptive analyses, we used a binomial logistic regression model to test the primary hypotheses of this study: burnout is predicted by both providers' perceptions of the impact of the COVID-19 pandemic and their perceptions of the consequent transition to telehealth. Provider burnout was measured by the statement, “I am experiencing burnout,” with response options on a Likert scale from Strongly agree to Strongly disagree. This was converted to a binary variable for our analyses. Of note, and as others have done, we chose not to use the 22-item validated measure of burnout to avoid over-burdening clinicians. The study was reviewed and approved by the CHOC Institutional Review Board (#200675). Results: Eighty-four providers responded (22%), which is typical for surveys of clinicians. The majority of respondents identified as female (57%). Additionally, 70% of participants were between 35 and 54 years old, with about 10% <35 years and 20% >54 years. Almost all respondents (92%) were married or in a domestic partnership. Approximately 46% of respondents were Specialists, 33% General Pediatricians, and 20% Hospitalists. Fifty-six percent of respondents reported that they were experiencing burnout (N=84). Table 1 summarizes key descriptive results, and Figure 1 presents the results of the multivariable logistic regression model predicting self-reported provider burnout. The data show that, when controlling for the other variables in the model, the self-reported experience of burnout is predicted by three perceptions: COVID-19 has exacerbated provider burnout (p<0.001), the benefits of telehealth do not outweigh the challenges (p=0.045), and there is insufficient institutional support to reduce burnout (p<0.001). We also identified a statistically significant interaction, with those perceiving both sufficient institutional support and telehealth to be beneficial being less likely to report experiencing burnout (p=0.045). Conclusion: Increased institutional support should be provided to clinicians both now, as clinical practice continues to evolve during the COVID-19 pandemic, and more proactively during the inevitable future periods of crisis in an effort to reduce clinician burnout in these difficult times. Future research should assess the effectiveness of different institutional measures on clinician wellbeing.
ABSTRACT
Background: Although the physical morbidity and mortality attributable to SARS-CoV-2 has predominantly affected adults, children remain at risk for serious complications. There has been substantial research regarding comorbid conditions, such as obesity and diabetes, and COVID-19 outcomes in adults, yet much is still unknown in the pediatric population. Study Objective: This study sought to examine comorbid conditions as risk factors associated with severe outcomes among pediatric COVID-19 patients. Methods: In this cross-sectional retrospective study we used data mining approaches on the Cerner multicenter dataset to retrieve an extensive list of comorbidities including pre-existing and concurrent conditions in hospitalized patients with SARS-CoV-2 (> 29 days and <21 years, hospitalized 3/1-6/30/20). Complications were defined as death or mechanical ventilator use. A nested mixed effects model was built on the most common comorbid conditions. All variables were assessed using the generalized variance inflation factor. Corresponding two-way statistical interactions with age were considered while controlling for patient demographics and payer type;the final model was selected using backward elimination procedures. Results: There were 2480 encounters from 2320 patients;17.1% required a ventilator and 0.85% died (19/21 patients who died required mechanical ventilation). 25.8% of patients were <2, 16% were 6-11, and 29.6% were 12-18. Male patients comprised 52.1%, and 48.3% were White/Caucasian, 21.8% were Hispanic, and 15.1% were African American/Black. Males were at 36% increased odds of complication (IOC), and Black/African American patients were found to be at 63% IOC. Patients with bacterial pneumonia and severe sepsis had 330% and 314% IOC respectively. Heart failure, 738% IOC, coagulation defect, 722% IOC, and patent ductus arteriosus (PDA), 693% IOC, were among the highest risk factors in this study. Obese patients had 246% IOC. Interestingly, the increased risk of complications in patients with epilepsy and acute kidney failure was age dependent. Patients with epilepsy > 5 years were at higher odds of complication and those odds increased with age, whereas younger patients with acute kidney failure were more at risk. The highest risk factor for complication was found to be ileus, OR=11.9. Of 40 patients with ileus, 3 died and 26 required mechanical ventilation. Conclusions: Risk factors for complications of SARS-CoV-2 infection encompass a variety of conditions including obesity, epilepsy, PDA, bacterial pneumonia, sepsis, acute kidney failure, and ileus. Further studies are needed to explore these associations which may help elucidate why certain children suffer increased complications as well as inform treatment decisions.