A Telehealth Approach to Addressing ICU Healthcare Worker Mental Health Distress

ABSTRACT

Rationale Burnout and distress amongst ICU staff are prevalent and have been exacerbated during the COVID-19 pandemic. In this context, recent data have revealed an increased incidence of adverse mental health events (AMHE) amongst healthcare workers (HCW). However, identifying HCWs at risk for AMHE and offering timely support services remains a challenge. Our aim is to develop a telehealth-based platform to provide mental health screening and tailored interventions to ICU HCW at an academic medical center. Methods: A multidisciplinary team comprised of clinical and behavioral psychologists, resiliency coordinators, pulmonary critical care fellows, and faculty iteratively developed a screening questionnaire using validated tools directed at various domains of mental health including sleep disturbance, depression, anxiety, PTSD, resiliency, alcohol misuse, and burnout. Using Research Electronic Data Capture (REDCap) with an integrated Twilio platform, we developed a text-based, interactive tool designed to 1) screen HCWs for AMHE, 2) communicate results to respondents in real-time, and 3) provide risk-stratified referrals to support services such as a mental health practitioner or self-help mobile applications. We performed cognitive pretesting on the amalgamated survey instrument with 6 ICU HCW stakeholders including three ICU RNs, one RT, and two physicians. We sought feedback on survey length, concerns about confidentiality, likelihood to accept mental health referrals, and pertinence of the questions to ICU HCWs. Feedback was obtained via a 4-question survey and through qualitative field notes. Results: The mean duration required to complete the survey during beta-testing was 6.97 mins +/-2.46 mins (SD). 100% of participants reported that the questionnaire was ”not overly burdensome” (5/6) or “minimally burdensome” (1/6). Participants were also “very confident” (4/6) or “confident” (2/6) their confidentiality would be maintained with this intervention. 83% (5/6) of participants stated that they were either “extremely likely” (3/6) or “likely” (2/6) to accept real-time feedback including a mental health referral if their responses suggest possible mental health distress. Only 17% (1/6) reported that they are unlikely to accept a mental health referral. All participants rated the pertinence of the questions to the healthcare workers to be high with 33% (2/6) characterizing the pertinence as excellent and 67% (4/6) as very good. Illustrative comments from the qualitative assessment are included in the Table. Conclusion: A telehealth-based platform for a mental health screening with real-time feedback and support service referral is feasible and was well-received by ICU HCW during cognitive pretesting.