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Hospital bed occupancy rate is an independent risk factor for COVID-19 inpatient mortality: a pandemic epicentre
Francesco Castagna1,2, Xiaonan Xue3, Omar Saeed1,2
1Albert Einstein College of Medicine, Bronx, New York, USA.
Insights
COVID-19 inpatient mortality decreased significantly over one year, correlating with hospital bed occupancy. Reducing bed occupancy is crucial for managing future pandemic patient care.
Area of Science:
- Healthcare Management
- Infectious Diseases
- Public Health Policy
Background:
- The COVID-19 pandemic in early 2020 overwhelmed New York City's healthcare system.
- This led to significant changes in hospital operations and COVID-19 treatment strategies.
Purpose of the Study:
- To examine inpatient mortality trends for COVID-19 patients.
- To assess the relationship between hospital strain and patient outcomes.
Main Methods:
- Retrospective chart review of COVID-19 admissions from March 2020 to February 2021.
- Patients grouped into 3-month intervals; hospital strain measured by bed occupancy.
- Multivariate analysis controlled for patient demographics, comorbidities, and illness severity.
Main Results:
- Inpatient mortality decreased from 25.0% to 10.8% over the study year.
- Remdesivir, steroids, and anticoagulants usage increased; hydroxychloroquine and antibiotics decreased.
- Higher bed occupancy (62%-118%) was significantly associated with increased 30-day in-hospital mortality (HR 1.007 per 1% increase).
Conclusions:
- COVID-19 inpatient mortality is directly associated with hospital bed occupancy rates.
- Strategic planning for future pandemics must include reducing bed occupancy to manage critically ill patients effectively.
Introduction:
COVID-19 first struck New York City in the spring of 2020, resulting in an unprecedented strain on our healthcare system and triggering multiple changes in public health policy governing hospital operations as well as therapeutic approaches to COVID-19. We examined inpatient mortality at our centre throughout the course of the pandemic.
Methods:
This is a retrospective chart review of clinical characteristics, treatments and outcome data of all patients admitted with COVID-19 from 1 March 2020 to 28 February 2021. Patients were grouped into 3-month quartiles. Hospital strain was assessed as per cent of occupied beds based on a normal bed capacity of 1491.
Results:
Inpatient mortality decreased from 25.0% in spring to 10.8% over the course of the year. During this time, use of remdesivir, steroids and anticoagulants increased; use of hydroxychloroquine and other antibiotics decreased. Daily bed occupancy ranged from 62% to 118%. In a multivariate model with all year's data controlling for demographics, comorbidities and acuity of illness, percentage of bed occupancy was associated with increased 30-day in-hospital mortality of patients with COVID-19 (0.7% mortality increase for each 1% increase in bed occupancy; HR 1.007, CI 1.001 to 1.013, p=0.004) CONCLUSION: Inpatient mortality from COVID-19 was associated with bed occupancy. Early reduction in epicentre hospital bed occupancy to accommodate acutely ill and resource-intensive patients should be a critical component in the strategic planning for future pandemics.
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