Covid and the Pediatric Anesthesiologist

Myron Yaster MD and Lynne Maxwell MD

As we rapidly approach the 1 millionth (yes 1 millionth!) U.S. Covid-19 death, this survey article describes how the disease affected members of the Society for Pediatric Anesthesia during its first 6 months.  I’ve asked Lynne to help review and edit this PAAD because of my bias…I was one of the authors/PIs of the study.  Before we discuss the findings, I’d like to get on my soapbox and implore all of you to respond to these surveys. Yes, I know all about survey fatigue…when I get one of these surveys in my mailbox my first reaction is “oh no, not another survey”!  To ensure quality and relevance to pediatric anesthesiologists, these SPA surveys have been vetted by several different SPA committees, are limited in number per year, and provide a window into ourselves and our practice that simply can not be obtained any other way.  Today’s article adds to a history of important survey results that have examined issues such as airway management, radiation safety, fertility, and burn out. So, when you get a SPA (or ASA) survey in your inbox PLEASE, PLEASE fill them out.  The response rate really matters.  And consider brainstorming with colleagues to create a survey that evaluates an issue important to our specialty. The guidelines for survey content, eligibility and submission area on the SPA website (https://pedsanesthesia.org/call-for-surveys/). Myron Yaster MD

Original article

Rebecca D Margolis, Kim M Strupp, Abbie O Beacham, Myron Yaster, Thomas M Austin, Andrew W Macrae, Laura Diaz-Berenstain, Norah R Janosy. The Effects of Coronavirus Disease 2019 on Pediatric Anesthesiologists: A Survey of the Members of the Society for Pediatric Anesthesia. Anesth Analg. 2022 Feb 1;134(2):348-356 PMID: 33439606

The coronavirus disease 2019 (COVID-19) pandemic has affected the personal and professional lives of all health care workers. Anesthesiologists frequently perform virus-aerosolizing procedures (eg, intubation and extubation) that place them at increased risk of infection. The authors sought to determine how the initial COVID-19 outbreak (first 6 months of 2020) affected members of the Society for Pediatric Anesthesia (SPA) on both personal and professional levels.

“561/3,245 (17%) members responded to the initial questionnaire. Because of COVID-19, 21.7% of respondents said they would change their clinical responsibilities, and 10.6% would decrease their professional working time. Women were more likely than men to anticipate a future COVID-19–related job change (odds ratio [OR] = 1.92, 95% confidence interval [CI], 1.12-2.63; P = .011), perhaps because of increased home responsibilities (OR = 2.63, 95% CI, 1.74-4.00; P < .001). Additionally, 14.2% of respondents planned to retire early, and 11.9% planned to retire later. Women and non-White respondents had higher likelihoods of burnout on univariate analysis (OR = 1.75, 95% CI, 1.06-2.94, P = .026 and OR = 1.82, 95% CI, 1.08-3.04, P = .017, respectively), and 25.1% of all respondents felt socially isolated. In addition, both changes in retirement planning and future occupational planning were strongly associated with total job satisfaction scores (both P < .001)”. Because the response rate was low, albeit adequate for analysis, a shorter follow-up survey was sent to non-responders, whose responses were similar to the primary survey respondents, diminishing the concern about non-responder bias.

Consistent with other research, “the COVID-19 pandemic has affected the personal and professional lives of pediatric anesthesiologists, albeit not equally, as women and under-represented minorities have been disproportionately impacted. The pandemic has significantly affected personal finances, home responsibilities, and retirement planning; reduced clinical and academic practice time and responsibilities; and increased feelings of social isolation, stress, burnout, and depression/anxiety”.

Thus, the effects of Covid-19 on the pediatric anesthesia work force are profound.  We are sure you are all familiar with the swiss cheese model of human error causation. The presence of holes in any one “slice” of the cheese does not normally cause a bad outcome because of the absence of aligning holes in other layers. However, if the holes in many layers momentarily line up to permit a trajectory of accident opportunity—catastrophe can occur.(1) Using Reason’s elucidation of the swiss cheese model in the context of COVID-19, there are both active failures and latent conditions.  The active failures? lack of protective equipment, unavailability of vaccination (in the time period covered by the survey), etc.  Latent conditions—as the term suggests—may lie dormant within the system for many years before they combine with active failures and local triggers to create an accident opportunity. Unlike active failures, whose specific forms are often hard to foresee, latent conditions can be identified and remedied before an adverse event occurs. Understanding this leads to proactive rather than reactive risk management. Examples of latent conditions? Lack of child or elder care, time pressure, understaffing, inadequate equipment, fatigue, inexperience, etc. (1)

Finally, the authors of this paper have been instrumental in forming SPA’s wellbeing special interest group (soon to be a committee) and the committee on Diversity, Equity, and Inclusion.  These committees are open to all members.  To paraphrase the great line from the movie Casablanca: Why not join the fight?

References

1.           Reason J. Human error: models and management. BMJ 2000;320:768-70.