Providing care during the pandemic: the anaesthetists’ perspective

On 17 March, one of my first tasks as a newly appointed clinical psychologist to the Theatres and Anaesthetics Department at Leeds Teaching Hospitals was to attend a COVID-19 planning meeting. On the day of the meeting, the anxiety in the room was palpable. I was given five minutes to speak about wellbeing. At the end of the meeting one of the consultants called me over, and asked me how we were going to prepare the anaesthetists for the fact that some of them were going to die.

Over the next few months, a handful of anaesthetists came forward to seek help, in contrast to over 100 theatre staff seeking psychological support. I was curious about the possible reasons for this - whether anaesthetists were more resilient, utilised other sources of support, or were more reluctant to seek help. In August I set up an electronic survey exploring anaesthetists’ experiences of working during the pandemic. The survey required respondents to complete several open-ended questions about their experiences, rate a number of stressors, and complete the Burnout Assessment Tool (BAT) [1]. The survey was sent out to 150 anaesthetists, comprising 140 consultant anaesthetists, five anaesthesia associates and five trainees (the latter small number because of the problems of rotations).

A total of 97 Anaesthetists completed the survey, a response rate of 64%. The majority were consultants (88%) with 51% male and 45% female respondents. Sixty-seven had continued to work in theatres during the pandemic, while 30 had been redeployed to ICU.

A quarter of respondents were at risk or likely to experience burnout, with 18% of respondents indicated high levels of emotional exhaustion (Table 1).

The survey identified that the build-up phase was one of the most difficult times. Many described anticipatory anxiety, struggling with uncertainty and emotional contagion from the anxiety of others. This seems to have settled for some as rotas commenced, “the anticipation of impending tsunami of cases caused more anxiety than actually having to deal with the patients when they arrived”.

Whilst working during the pandemic, the main challenges were the stress of wearing PPE for long hours and dealing with constant changes in rules and guidelines. There were difficulties in communicating effectively with patients, trauma of seeing their fear and “watching the same patients slowly dying despite all medical therapy”.

Unsurprisingly the main concerns current at the time of the survey related to fears of a second wave. Having no clear end in sight in dealing with the crisis continues to have an impact on anaesthetists, for example “I might have to wear full PPE until I retire”.

There was clearly a sense of camaraderie and team spirit in the department that enabled people to pull through. One person commented “It is the most can-do response I have seen from staff in my career”. In addition, being able to “rediscover simple anaesthesia”, and finding more appreciation in everyday life, were positives that some people were able to take away. There was a sense that the department had been prepared and coped as well as it could.

The findings of the study are consistent with other research. A RCoA survey found that 64% of anaesthetists had suffered mental distress because of additional work stressors due to COVID-19, with 12% at risk of burnout [2]. Tsan et al. found that 55.3% of anaesthetists were classified as having burnout, and 31.8% reported high emotional exhaustion, in an exclusive COVID-19 hospital in Malaysia [3]. Jain et al. noted that 80% of 417 anaesthetists had a score of ≥ 5 on the GAD-7 measure of anxiety [4].

COVID-19 will continue as a public health crisis for some time. It will be essential for safeguarding the wellbeing of staff to address its impact and put preventative measures in place. Initiatives that we are developing include facilitating peer support and providing access to psychological interventions.

Dr Jennie Ormerod
Clinical Psychologist
Leeds Teaching Hospital NHS Trust

References

1. KU Leuven. Manual Burnout Assessment Tool (BAT), 2019. https://limo.libis.be/primo-explore/fulldisplay?docid=LIRIAS2949774&context=L&vid=Lirias&search_scope=Lirias&tab=default_tab&lang=en_US&fromSitemap=1 (accessed 13/10/2020).
2. Royal College of Anaesthetists. View from the frontline of anaesthesia during COVID 19, July 2020 survey results, 2020. https://www.rcoa.ac.uk/policy-communications/policy-public-affairs/views-frontline-anaesthesia-during-covid-19-pandemic-July2020 (accessed 1/8/2020).
3. Tsan SEH, Kamalanathan A, Lee CK, Zakaria SA, Wang CY. A survey on burnout and depression risk among anaesthetists during COVID‐19: the tip of an iceberg? Anaesthesia 2020; doi: 10.1111/anae.15231. 
4. Jain A, Singariya G, Kamal M, Kumar M, Jain A, Solanki RK. COVID-19 pandemic: Psychological impact on anaesthesiologists. Indian Journal of Anaesthesia 2020; 64: 774.

Table 1.
Results of the Burnout Assessment Tool in 97 anaesthetists. Values are number (proportion).

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