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Impact of COVID-19 on inpatient clinical emergencies: A single-center experience

Oscar J L Mitchell1, Stacie Neefe2, Jennifer C Ginestra1,3

  • 1Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, United States.

Resuscitation Plus
|May 10, 2021
PubMed

Insights

Rapid response team (RRT) activations for respiratory distress increased significantly during the COVID-19 surge. New clinical tools and strategies were developed to manage these complex cases, offering valuable insights for other hospitals.

Area of Science:

  • Medical Research
  • Critical Care Medicine
  • Epidemiology

Background:

  • The COVID-19 pandemic led to unprecedented surges in hospitalizations.
  • Rapid Response Teams (RRTs) are crucial for managing deteriorating patients in hospitals.
  • Understanding changes in RRT activations during COVID-19 surges is essential for healthcare system adaptation.

Purpose of the Study:

  • To determine changes in RRT activations during the COVID-19 pandemic.
  • To describe institutional adaptations implemented in response to increased COVID-19 hospitalizations.
  • To analyze RRT activation characteristics for COVID-19 and non-COVID-19 patients.

Main Methods:

  • Prospective data collection comparing RRT calls during the COVID-19 era (March 7-May 31, 2020) with a pre-COVID-19 era (January 1-March 6, 2020).
  • Negative binomial regression analysis to compare RRT activation rates normalized to floor census.
  • Analysis of RRT activation causes and patient demographics during the surge period.

Main Results:

  • RRT activations for respiratory distress significantly increased during the COVID-19 surge (2.38 vs. 1.27 per 1000 floor patient-days, p=0.02).
  • All-cause RRT rates did not differ significantly between eras (5.40 vs. 4.83 per 1000 floor patient-days, p=0.52).
  • Respiratory distress was a more frequent cause of RRT activation in COVID-19 patients (57%) compared to non-COVID-19 patients (28%, p=0.001).

Conclusions:

  • The surge in COVID-19 cases led to a higher frequency and complexity of RRT activations for respiratory distress.
  • Institutional adaptations included revised RRT guidelines, decision-support pathways, and expanded critical care support.
  • Developed clinical tools and strategies during the COVID-19 surge can be valuable for other healthcare institutions facing similar challenges.
Abstract

Keywords:
COVID-19Clinical emergenciesCoronavirusMedical emergency response teamPatient safetyRapid response team

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