Introduction: The COVID-19 pandemic has resulted in over 42 million infections in the United States with over 667,000 reported deaths. Hospitalization occurs in 10-15% of patients with COVID-19 and around 5% of patients require management in the intensive care unit (ICU). Hospitals have put visitation restrictions in place to control infections, limiting caregiver access. Caregivers of ICU patients are placed in an unexpected role of advocate and often report unmet needs related to education and preparation for transition out of the hospital. Prior to the pandemic, visitors in the neuroscience ICU (NSICU) had unrestricted access to patients during daytime hours and were able to be present for in-person education and engagement. Due to pandemic restrictions, visitation was limited in the NSICU, increased to two-hour intervals every 48 hours with daily phone calls attempted for updates. This restriction is compounded by variable visitation at nursing facilities and long-term acute care centers, further increasing the expected burden on the caregiver experience with NSICU patients. We anticipated that the reduced time for in-person visitation had a negative impact on the emotional status of family members and led to knowledge or skill gaps in their roles as family advocates and caregivers. Understanding these unmet needs will help provide preliminary data to guide future interventions to address the needs of patients and families when in-person visitation is restricted.

Methods:  The census of NSICU patients from April 1, 2020 to September 30, 2020 was used to screen and select patients who had identifiable caregivers and an eligible stay in the NSICU. Once identified, potential participants were contacted by phone and caregivers and patients willing to participate were consented electronically. The caregivers then completed a standardized interview over the phone which was recorded and transcribed for analysis. These transcripts will be reviewed and coded into themes utilizing a directed content analysis and predefined code list which captures the key unmet needs and concerns identified by the caregivers. These coded themes will be analyzed and from them a list of unmet needs and concerns of caregivers will be generated.

Results: Currently, 330 patient records have been reviewed, 73 of which met inclusion and exclusion criteria and 5 have responded and completed an interview. Primary inclusion criteria are identification as a caregiver of an adult patient in the NSICU for which English is their primary spoken language. Primary exclusion criteria include a length of stay less than 72 hours, transfer from another ICU, patients who are pregnant or prisoners, and patients and/or caregivers not living at home prior to admission.

Conclusions: Interviews are ongoing, and it is difficult to draw any conclusions at this time due to limited preliminary data. Data gathering and analysis is projected to be completed by December 2021.