Dear Editor,

As the COVID‐19 pandemic continues to wreak havoc across the world, and particularly in the United States, emergency veterinary hospitals face on‐going challenges. We previously shared information gathered from survey data in April 2020.1 We have continued to survey emergency veterinary hospitals and share some updates from surveys of 32 hospitals from May 5, 29 hospitals from May 20; 30 hospitals June 4; and 21 hospitals June 29.

A few key themes emerge from the surveys that have been echoed on listservs, social media, and other informal platforms. First, the overall caseload and demand for emergency and specialty level care for companion animals has increased as compared to previous years. The majority of hospitals reported caseload increases of greater than 10%, with 44% (14/32) hospitals reporting an increase of >25%. Most hospitals had not made significant changes to structure or staff to accommodate increased caseload, although a few reported intermittent diversions or closures when caseload exceeded capacity. Staffing shortages were common, and worsened by potential exposures, infections or other COVID‐related absences. Burnout among staff was considered high. Although many hospitals had put additional supports in place for employees, no one solution was clearly effective; various efforts included increased access to social workers or online groups, efforts at team building, schedule flexibility within reason, tee‐shirts, and meals. Additional “hazard” pay for frontline employees was rarely offered.

Most hospitals were continuing with curb side care and limited or no client access to buildings. Seventy‐six percent (22/29) permitted clients in the hospital only for euthanasia, while 24% (7/29) permitted clients for other reasons, although it was typically restricted access. Only 13% (4/30) of hospitals were permitting clients to visit hospitalized pets, with 16 of 30 (53%) offering virtual visitation as an alternative to in‐person visits.

As of June 20, 16 of 21 (76%) of hospitals surveyed had no plans to allow clients back into the building for appointments. Staff were frequently asked or pressured for more access with 11 of 21 (52%) were being asked more than once every day, five of 21 (24%) occasionally, and four of 21 (19%) rarely. Only one hospital, located in Washington State, said clients were understanding about limited access.

In summary, increased caseload and burnout seem to be the biggest challenges for emergency veterinary hospitals during the COVID‐19 pandemic, coupled with the unpredictable future. On‐going support of team members and among the emergency/critical care community is vital, and we plan to continue surveys and data dissemination.

亲爱的编辑，

随着COVID-19大流行继续在世界范围内造成严重破坏，尤其是在美国，急诊兽医医院面临持续的挑战。我们之前共享了从2020年4月的调查数据中收集的信息。1我们继续对急诊兽医医院进行调查，并共享5月5日对32家医院的调查和5月20日以来29家医院的调查的一些更新；6月4日，共有30家医院；6月29日和21家医院。

调查产生了一些关键主题，这些主题在列表服务，社交媒体和其他非正式平台上得到了回应。首先，与往年相比，整体病例量以及对陪伴动物的紧急和专科护理的需求有所增加。大多数医院报告的病例增加超过10％，其中44％（14/32）的医院报告病例增加超过25％。大多数医院并未对结构或人员进行重大更改以适应不断增加的案件量，尽管少数医院报告说，当案件量超出容量时，会间歇性地改道或关闭。人员短缺普遍存在，并因潜在的暴露，感染或其他与COVID相关的缺勤而加剧。工作人员的倦怠被认为很高。尽管许多医院都为员工提供了额外的支持，没有一个解决方案明显有效；各种努力包括增加与社会工作者或在线团体的接触，团队建设的努力，日程安排的灵活性，T恤和进餐。很少为一线员工提供额外的“危险”薪酬。

大多数医院都继续提供路边护理，服务对象进入建筑物的机会有限或没有。百分之七十六（22/29）的病人允许安乐死入院，而有24％（7/29）的病人因其他原因允许安乐死，尽管通常情况下会受到限制。只有13％（4/30）的医院允许客户探访住院的宠物，其中30家医院中的16（53％）提供虚拟探视，以代替亲自探视。

截至6月20日，接受调查的21家医院中有16家（占76％）没有计划允许客户返回大楼进行预约。员工经常被要求或被迫获得更多使用权，其中每天21人中的11人（52％）每天被问及不止一次，21人中有5人（24％）偶尔被问及，21人中有4人（19％）很少被问到。华盛顿州只有一家医院表示，客户对有限的出入了解。

总之，在COVID-19大流行期间，病案数量增加和工作倦怠似乎是急诊兽医医院面临的最大挑战，加上前途未卜。团队成员以及急救/重症监护社区不断提供支持至关重要，我们计划继续进行调查和数据分发。