A Multidisciplinary Survey Comparing Academic and Community Critical Care Clinicians' ARDS Practice and the COVID-19 Pandemic.

Abstract

Rationale: Barriers to recognizing and treating acute respiratory distress syndrome (ARDS) exist. Prior studies have not investigated whether these barriers differ between academic and community settings, nor whether there were differences in critical care clinicians' reported ARDS management strategies during the COVID-19 pandemic.

Objectives: Grounded in the Consolidated Framework for Implementation Research, we sought to determine whether there are differences between academic and community critical care clinicians in their team- and ICU-based culture; interprofessional communication; knowledge, attitudes, and perceived barriers to ARDS recognition and management; and their ICU organization and ARDS management associated with the COVID-19 pandemic.

Methods: Multidisciplinary survey from September, 2020 to April, 2021 of critical care physicians, nurses, advanced practice providers, and respiratory therapists (RTs) in six academic and nine community hospitals across the United States and Canada. Individual item and cumulative domain scores were compared between academic and community clinicians. Statistical adjustment was performed for multiple comparisons.

Results: 1,906 clinicians responded to at least one survey item (53% response rate). Mean (SD) culture scores were higher for community physicians vs. academic physicians (5.3 [1.8] vs. 4.4 [2.0], P<0.001) and community nurses vs. academic nurses (4.4 [2.2] vs. 3.8 [2.1], P=0.007). Academic nurses and RTs had higher knowledge scores compared to community nurses and RTs (P<0.001 for each comparison). Community physicians, nurses, and RTs reported higher mean (SD) number of changes in ICU organization and practice during the COVID-19 pandemic compared to academic clinicians (e.g., community physicians: 13.7 [2.7] changes vs. academic physicians: 11.8 [4.3] changes, P=0.001). While academic physicians, nurses, and RTs were approximately twice as likely to care for ARDS patients daily or several days per week compared to community clinicians, ARDS management, attitudes, and belief in evidence was similar between academic and community clinicians in most respects.

Conclusions: A large, multidisciplinary survey identified differences between academic and community critical care clinicians' culture and knowledge in the care of ARDS patients. The COVID-19 pandemic had a greater impact on community ICU organization and ARDS management. Multifaceted implementation strategies should target implementation barriers differently in academic and community settings.