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Published on: September 24, 2020
Unexpected ICU Transfer and Mortality in COVID-19 Related to Hospital Volume
Cassidy M Dahn1, Sana Maheshwari2, Danielle Stansky2
1NYU Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, Division of Critical Care, New York, New York.
Insights
During COVID-19 surges, patients unexpectedly transferred to the intensive care unit (ICU) had significantly higher mortality rates, regardless of their COVID-19 status. This highlights the critical impact of hospital capacity on patient outcomes.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Health Systems Research
Background:
- The COVID-19 pandemic placed immense strain on healthcare systems globally, particularly intensive care units (ICUs).
- Identifying patients at high risk of rapid deterioration and subsequent ICU transfer is crucial for resource allocation and patient management.
- Understanding the impact of hospital surge capacity on patient outcomes is essential for effective healthcare system preparedness.
Purpose of the Study:
- To investigate the characteristics and outcomes of patients requiring unexpected ICU transfer (UIT) within 24 hours of non-ICU admission.
- To compare UIT rates and mortality between COVID-19 positive and negative patients during periods of high (surge) and low (non-surge) hospital capacity.
- To determine the effect of hospital surge conditions on the outcomes of patients experiencing rapid clinical deterioration.
Main Methods:
- Retrospective cohort study across a single health system with four EDs and three tertiary hospitals.
- Analysis of electronic health records for patients admitted to non-ICU settings with UIT within 24 hours.
- Comparison of adult patients with and without confirmed COVID-19 during surge and non-surge periods.
Main Results:
- During surge periods, 86 UITs occurred; 60 COVID-19 positive patients had a 63.3% mortality rate, and 26 COVID-19 negative patients had a 30.8% mortality rate.
- During non-surge periods, 112 UITs occurred; 24 COVID-19 positive patients had a 37.5% mortality rate, and 90 COVID-19 negative patients had an 11.1% mortality rate.
- The mortality rate for both COVID-19 positive and negative patients with UIT was significantly higher during the surge period.
Conclusions:
- Hospital surge conditions during the COVID-19 pandemic were associated with significantly higher mortality rates for patients requiring unexpected ICU transfer.
- Both COVID-19 positive and negative patients faced increased mortality risk when transferred to the ICU unexpectedly during peak hospital demand.
- These findings underscore the critical impact of healthcare system capacity on patient outcomes during public health crises.
Introduction:
Coronavirus 2019 (COVID-19) illness continues to affect national and global hospital systems, with a particularly high burden to intensive care unit (ICU) beds and resources. It is critical to identify patients who initially do not require ICU resources but subsequently rapidly deteriorate. We investigated patient populations during COVID-19 at times of full or near-full (surge) and non-full (non-surge) hospital capacity to determine the effect on those who may need a higher level of care or deteriorate quickly, defined as requiring a transfer to ICU within 24 hours of admission to a non-ICU level of care, and to provide further knowledge on this high-risk group of patients.
Methods:
This was a retrospective cohort study of a single health system comprising four emergency departments and three tertiary hospitals in New York, NY, across two different time periods (during surge and non-surge inpatient volume times during the COVID-19 pandemic). We queried the electronic health record for all patients admitted to a non-ICU setting with unexpected ICU transfer (UIT) within 24 hours of admission. We then made a comparison between adult patients with confirmed coronavirus 2019 and without during surge and non-surge time periods.
Results:
During the surge period, there was a total of 86 UITs in a one-month period. Of those, 60 were COVID-19 positive patients who had a mortality rate of 63.3%, and 26 were COVID-19 negative with a 30.8 % mortality rate. During the non-surge period, there was a total of 112 UITs; of those, 24 were COVID-19 positive with a 37.5% mortality rate, and 90 were COVID-19 negative with a 11.1% mortality rate.
Conclusion:
During the surge, the mortality rate for both COVID-19 positive and COVID-19 negative patients experiencing an unexpected ICU transfer was significantly higher.
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