The SEMICYUC Planning, Organization and Management Working Group and the Infectious Diseases and Sepsis Working Group developed a 113-question questionnaire that includes the following sections: 1: participant data and site baseline general data, 2: material and human resources available before and during the pandemic, 3: transversal structures created in the hospital, 4: organization and care load before and during the pandemic, 5: subjective perception of the impact of the pandemic on the role and visibility of Intensive Care Medicine, 6: impact of the pandemic on non-care activity (education, investigation…) and evaluation of activities and documents. January 2020 and February 2021 were considered as pre-pandemic and post-pandemic references, respectively. The questionnaire used can be consulted (21).
The project was approved by the Managing Board of SEMICYUC and sent to partners by e-mail. The survey period was from 15th to April 20th 2021. Responses were voluntary and anonymous. No personal data was recorded although data on job post and unit were requested. Ethics committee approval was not considered necessary because of the type of study. The survey was voluntary, not remunerated and consent to use the data obtained was deemed implicit for taking part. For the analysis, hospitals were classified as under 200 beds, 200-500 beds and more than 500 beds.
For sections 2, 3 and 4 we analysed one response per hospital. In the event of receiving more than one answer per site, we selected the answer according to a hierarchical order (head of department, clinical chief, specialist, fellow). For the remaining sections, data is shown in aggregate form.
Percentage increases (for beds, closed boxes, negative pressure boxes, staff and guard number) were calculated using the following formula:
Percentage increase (increase %) variable X=(variable X February 2021-variable X January 2020)/variable X January 2020 x 100.
Results are shown as absolute value and percentage, and as median and p25 and p75 for qualitative and quantitative variables, respectively. Answers were analysed according to hospital size. Qualitative and quantitative variables were compared using the statistical Chi2 and Kruskall-Wallis tests, respectively. Statistically significant differences were deemed those with p<0.05.Results:
We received 246 answers from 157 hospitals, representing the 17 autonomous communities in which Spain is administratively distributed (Additional File 1). Of the total SEMICYUC partners who responded, 58 (23.6%) were heads of department, 15 (6.1%) clinical chief, 128 (50.4%) specialists 12 (4.9%) fellows. The median experience in the ICU was 18 (9, 25) years. A total of 108 (68.4%) of the analyzed hospitals offered training in Intensive Care Medicine.
Material and human resources available during the pandemic (Table 1)
Capacity was increased in 67.7% of Spanish ICUs with an increase of 9 (4, 18) beds, which represents 58.6% compared to the number of pre-pandemic beds. The number of ICU medical staff increased by 6.1% (there was no increase in small and medium-sized hospitals, however, there was an increase of 10.6% in hospitals with more than 500 beds, p=0.014).
In 119 (75.3%) units there was at least one doctor infected with SARS-CoV-2: in 7 (46.7%) ICU from hospitals with <200 beds, 62 (76.5%) from hospitals with 200-500 beds and 50 (80.6%) from hospitals >500 beds (p=0.022).
On the date of completing the survey, 229 (93.1%) of respondents had received at least one dose of the vaccine.
Transversal structures created in the hospital (Table 2)
Only 15.8% of hospitals did not design a Contingency Plan and 29.1% did not have a de-escalation plan. A COVID committee was created in 77.8% of the hospitals.
Treatment organization and work overload (Table 3)
Collaboration with other specialists was necessary in 88% of the hospitals due to the excessive number of patients, that exceeded 200% of ICU pre-pandemic capacity.
The negative impact of the pandemic on the assistance quality, marked on a scale from 0 to 10, was evaluated as 8 (7, 10) but only 19 (12%) units used quality indicators to measure this issue. Using the same scale, concern over higher than usual mortality was graded as 9 (7, 10). Concern over insufficient individual protection equipment (IPE) during the first wave was graded as 9 (8, 10) and concern for being infected with SARS-CoV-2 was graded as 9 (8, 10). At the time of completing the survey, these concerns were lower: lack of IPE: 3 (2, 6) and infection: 6 (4, 7).
Subjective perception of the role of Intensive Care Medicine during the pandemic (Table 4)
61.8%, 79.3% and 89.4% of the participants have the feeling that the opinion about the ICU has improved for hospital manager, for other specialists and for the general population (respectively). Self-evaluation of the work performed was outstanding and 91.9% drew pride from their work. However, 16.7% experienced regretted becoming intensivist (especially in hospitals with 200-500 beds) and up to 15% considered leaving their job.
Impact of the pandemic on non-assistance activity and evaluation of activities and documents (Table 5)
64.2%, 85.8% and 76.8% of the participants consider that the pandemic has had a negative effect on fellow training, continuous medical education and on research, respectively.