COVID-19 surges and hospital outcomes in the United States

To examine the impact of COVID-19 surges on hospital outcomes, particularly among non-COVID-19 patients.

An interrupted time series design.

Using data from a large insurance claims clearinghouse, the study estimates the impact of the onset of the pandemic and the share of hospital COVID-19 patients on the likelihood of (1) in-hospital death, (2) in-hospital death or discharge to hospice, (3) discharge to other hospitals, (4) discharge to skilled nursing facilities (SNFs), and (5) discharge to home care.

The odds of in-hospital death were about 1.7 times that before the onset of the pandemic among all patients and 1.2 times that among non-COVID-19 patients. Increased share of COVID-19 patients was associated with higher odds of in-hospital death among all patients and non-COVID-19 patients. The effects were more pronounced among patients 45 years and older and those with septicemia or pneumonia, and they were also stronger during the months in which COVID-19 cases surged. Although no sizable changes were found in the odds of discharge to other hospitals or SNFs, transfers to home care grew during the pandemic.

The negative impact of the pandemic on mortality among non-COVID-19 patients confirms existing concerns about patient care. No evidence suggests large-scale changes in practices regarding discharge/transfer to other facilities. The findings shed light on future efforts to monitor and improve inpatient care as the pandemic evolves.