The preparedness and response to COVID-19 in a quaternary Intensive Care Unit in Australia: perspectives and insights from frontline critical care clinicians

  1. Krishnaswamy Sundararajan
  2. Peng Bi
  3. Adriana Milazzo
  4. Alexis Poole
  5. Benjamin Reddi
  6. Mohammad Afzal Mahmood
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Abstract

Objectives

This study was conducted to explore the perspectives and opinions of Intensive Care Unit (ICU) nurses and doctors at a COVID-19 designated pandemic hospital concerning the preparedness and response to COVID-19 and to consolidate the lessons learnt for crisis/disaster management in the future.

Design

A qualitative study using in-depth interviews (IDIs) and focus group discussions (FGDs). Purposeful sampling was conducted to identify participants. A semi-structured guide was utilised to facilitate in-depth interviews with individual participants. Two focus group discussions were conducted, one with the ICU doctors and another with the ICU nurses. Thematic analysis identified themes and subthemes informing about the level of preparedness, response measures, processes, and factors that were either facilitators or those that triggered challenges.

Setting

ICU in a quaternary referral centre affiliated to a university teaching COVID-19 designated pandemic hospital, in Adelaide, South Australia.

Participants

The participants included eight ICU doctors and eight ICU nurses for the in-depth interviews. Another sixteen clinicians participated in focus group discussions.

Results

The study identified six themes relevant to preparedness for, and responses to, COVID-19. The themes included: (1) Staff competence and planning, (2) Information transfer and communication, (3) Education and skills for the safe use of PPE, (4) Team dynamics and clinical practice, (5) leadership, and (6) Managing End-of life situations and expectations of caregivers.

Conclusion

Findings highlight that preparedness and response to the COVID-19 crisis were proportionate to the situation’s gravity. More enablers than barriers were identified. However, opportunities for improvement were recognised in the domains of planning, logistics, self-sufficiency with equipment, operational and strategic oversight, communication, and managing end-of-life care.

ARTICLE SUMMARY

Strengths and limitations of this study

  • This is the first study that provided insights about clinicians’ perspectives and viewpoints to preparing and responding to COVID-19 in Australia.

  • The study used qualitative methodological framework allowing participants to provide in-depth accounts of processes and enabling factors and barriers.

  • Our study provides information on issues that needs to be addressed from a critical care viewpoint and interventions that were effective and efficient

  • This is a single-center study in a developed country where experience is vastly different from other centers with higher demand and fewer resources

  • We acknowledge the potential for selection bias because of the qualitative design

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