Audit on the perceptions of the impact of Covid-19 and department support amongst emergency healthcare workers at Wagga Base Hospital

Introduction

The COVID-19 pandemic has created an unprecedented challenge for the public healthcare system and those who work within it. The first positive case of COVID-19 in the Murrumbidgee Local Health District (MLHD) was confirmed on the 23rd of March, and case numbers continued to rise. Recognising how the threat of COVID-19 could increase levels of pressure and anxiety amongst health-care workers, and induce concerns about physical and mental health, we sought to assess the prevalence of these concerns amongst staff members who worked in the Emergency Department (ED) at Wagga Wagga Base Hospital (WWBH). Whether participants felt they had a sound understanding of COVID-19 related protocols, and levels of perceived support within the ED, were also assessed. We hypothesised that as the number of cases in the MLHD increased, rates of self-reported anxiety and concerns regarding mental and physical health would increase.

Methods

We conducted a cross-sectional observational study using de-identified self-reported seven-point surveys, which were distributed to ED staff in April and May. Data was extracted manually from the surveys, and was managed and analysed using Stata. Data analysis was performed by the investigators, with chi-square testing used to assess for differences in agreement with the seven statements using comparisons between April and May surveys, as well as between doctors and nurses, and junior and senior staff.

Results

One hundred and twenty four surveys were completed. Sixty five were completed in April, and 59 in May. Thirty surveys were completed by doctors, 72 by nurses and 22 by administrative staff. Forty-eight surveys were completed by staff who identified as senior, 37 by junior staff and 39 did not designate a level of seniority.

Around half of all survey participants reported increased levels of pressure and anxiety at or regarding work. Approximately one third expressed concerns about their own mental health in April, however, in May there was a significant decline in these concerns. Over three quarters of respondents reported having a good understanding of the COVID-related health and safety protocols in both April and May. Respondents almost universally felt well supported by the Wagga Base Hospital Emergency Department.

Subgroup analyses showed higher rates of concern about mental health amongst junior staff compared to senior staff in April, but there was no difference between the groups in May. Nurses were also more likely to report a better understanding of the health and safety protocols in May when compared to doctors. Further, nurses were more likely than doctors to report feeling well supported by the WWBH Emergency Department in May, although the rate of this perception of support was over 80% in both groups, and across both timeframes.

Discussion

This study was able to demonstrate clear differences in concerns about work-related pressure, anxiety, physical and mental health, understanding of health and safety protocols, and perceptions of support from the ED amongst staff. Despite concerns about selection and measurement biases, we found significant differences in the rates of concerns about mental health amongst junior and senior staff, and we hypothesised this may be related to the protective effect of experience for senior staff.

We had hypothesised that as cases COVID-19 increased, rates of concern about anxiety and pressure would increase, but instead we found the inverse to be true. We found that levels of concern about mental health were reduced amongst all participants between April and May as the threat of the pandemic appeared to become more manageable and the curve of case numbers was flattened in New South Wales. Nursing staff reported higher rates of understanding of the health and safety procedures than doctors in May. We speculated this could be due to more structured clinical and procedural handovers we observed on the floor in the Emergency Department every shift change, which could, in turn, facilitate better understanding and high rates of perceived support among nurses, than their doctor counterparts.

Conclusion

In light of the second-wave of COVID-19 in Victoria and in many health jurisdictions throughout the world, we anticipate an ongoing need to monitor and support healthcare workers given high rates of concern about mental and physical health. We hypothesise that that a spike in cases could correspond with higher rates of concern, and healthcare services should be aware that junior staff may be more likely to report mental health concerns than their senior counterparts. Further, dedicated time for clinical and procedural handover is likely to lead to high self-reported levels of understanding of health and safety protocols amongst healthcare workers. This may translate to higher rates of perceived support from the healthcare service.