A Multidisciplinary Survey Comparing Academic and Community Critical Care Clinicians’ Acute Respiratory Distress Syndrome Practice and the COVID-19 Pandemic
Bibliographic record
Abstract
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 or whether there were differences in critical care clinicians’ reported ARDS management strategies during the coronavirus disease (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 intensive care unit (ICU)-based culture; interprofessional communication; knowledge, attitudes, and perceived barriers to ARDS recognition and management; and 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 A total of 1,906 clinicians responded to at least one survey item (53% response rate). Mean (standard deviation [SD]) culture scores were higher for community physicians versus academic physicians (5.3 [1.8] vs. 4.4 [2.0]; P < 0.001) and community nurses versus academic nurses (4.4 [2.2] vs. 3.8 [2.1]; P = 0.007). Academic nurses and RTs had higher knowledge scores than 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 than academic clinicians (e.g., community physicians: 13.7 [2.7] changes vs. academic physicians: 11.8 [4.3] changes; P = 0.001). Although academic physicians, nurses, and RTs were approximately twice as likely to care for patients with ARDS daily or several days per week compared with 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 patients with ARDS. 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.015 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".