Table 1

Impacts of COVID-19 pandemic on clinical procedures

SubthemeLevelIllustrative quote
COVID testing
Delay in care1,3Any trauma who is intubated (which is most of our sick trauma patients) is considered COVID positive coming in and we have to perform the initial resuscitation and evaluation in airborne precautions and limit people/supplies in the room. This can sometimes cause a delay in some of the care.—fieldnote
Impact on quality of care1,2,3… sometimes patients have you know what normally we would consider to be relatively urgent things and we would just get the patient down to the OR quickly because there is the potential for them to decompensate. They might not be dying in front of you, but there is the potential for them to decompensate. And that sort of decision of like ‘hey should we like in this situation to preserve PPE, like get this COVID test and wait because we think the patient’s kind of going to be able to make it a few hours without decompensating,’ that I find kind of challenging because it feels like you’re sometimes providing maybe not the best care because normally you would go straight down to the operating room but there’s also all these layers of if I do that, you know it uses this much more PPE and what not.—debriefing interview
Guideline uncertainty1,3,4Constantly evolving pathways for COVID testing and clearance which is understandable but no clear consensus on a day to day basis, or at least a lot of confusion.—fieldnote
Social distancing
Impact on procedures1,3I think, you know, we’re a teaching hospital so anything that happens, anything that happened, I should say in the past, happened with a large group of people. You know there’s the people who are performing the task and then the observers who are learning. The observers are no longer present for any of that. And even the activities that are being provided have been rethought to a point where we can pare them down to just the minimum number required. And so, so yes absolutely. There’s a significant amount of workflow changes that occurred to minimize the numbers of people that are involved.—debriefing interview
Reducing patient need to visit ED1,2,3Worked with patient to avoid ER a few weeks ago after a fall by coordinating nurse & doctor phone call; resulted in patient creating sling and icing injury. Resolved without visit to ER. Pt needs to go to doctor & physical therapy often for pain management and routine care for chronic conditions. Clinics do not want her coming in because not “absolutely necessary.”—jotting
Impacts on provider interactions1,3,4Also, we note the geography of our ED has changed so keep >6 feet of space between patients and allow for providers in patient care areas, so providers no longer congregate together in non-clinical spaces and sit separate from nurses which decreases clinical communication. There were no bad outcomes, just notable how much harder it is to communicate as a whole clinical team.—fieldnote
Reduced presence of family members1,3,4And then I really think one of the biggest things that’s been sort of hard I think for us as a group and I think for all healthcare providers sort of who are taking care of any patient, COVID positive or not, is that, is the fact that you know we really aren’t able to have family members in the hospital almost at all, which is a very different way than we usually practice. And that’s been really hard I think on everyone in sort of the hospital but also the patients and their families.—debriefing interview
Use of telehealth1,3,4Before, when all this started we were not set up for telehealth in anyway, we did do phone calls that’s always been something but it was seen as only, we only did that if there was some really extenuating circumstances, or if something was so minor that it just seemed better to do it over phone. So as soon as really drastic measures were being taken place to call patients like “do you really need this, or can you wait until June”. You know things started to be more and more integrated into the telehealth way and Zoom was being used.—debriefing interview
Impact on quality of care3,4One of the patients who has a lot of chronic illnesses…, he self-identified as someone whose not a phone person and is, notices himself that as engaged as much and getting distracted over the phone, and just is the kind of person that favors in person contact for a variety of reasons. And so, it really inhibited our work together and that he is less able to get into to a state of readiness to do therapeutic work because he’s just distracted and then generally seeming feeling a lot more hopeless. -debriefing interview
Use of PPE
Impacts on procedures1,3It also limits our ability, like we as the attendings don’t go into the room. We sort of stand back, not in airborne, N-95 precautions, we sort of stand back to preserve PPE because we usually don’t, you know we’re not usually the ones like doing stuff to the patient—fieldnote
Impact on interactions with patients3,4I think that some people do feel apprehensive that they can’t see your face but also that you know you may be a risk to them, and sort of I feel like sometimes sends that signal even though you’re trying to obviously do the right thing and protect them. I mean classically people have worn masks in hospitals when they have been sick, right? I mean that’s why we’ve worn masks, is if you have like a runny nose or a cough or something. Just as an extra layer of protection. So, it’s always been like oh stay away from that person with the mask on because they’re you know sick.—debriefing interview
Challenges in wearing3,4I don’t know if you’ve seen these masks, I mean you know, we have the tie masks, they’re impossible, like you can’t wear them all day and getting them on and off, I got a bunch somewhere, but they’re hard to tie, so you’re thinking about how to sterilize them, and the, they’re tie masks they’re not like, they used to have better ear masks but they are conserving those for the patients, those stay on, these, these don’t unless you’re really good at tying them.—debriefing interview
  • PPE, personal protective equipment.