Abstract
ObjectivesTo describe the relationship between reported serious operational problems (SOPs), and mortality for patients with COVID-19 admitted to intensive care units (ICUs).DesignEnglish national retrospective cohort study.Setting89 English hospital trusts (i.e. small groups of hospitals functioning as single operational units).PatientsAll adults with COVID-19 admitted to ICU between 2nd April and 1st December, 2020 (n = 6,737).InterventionsN/AMain outcomes and measuresHospital trusts routinely submit declarations of whether they have experienced ‘serious operational problems’ in the last 24 hours (e.g. due to staffing issues, adverse weather conditions, etc.). Bayesian hierarchical models were used to estimate the association between in-hospital mortality (binary outcome) and: 1) an indicator for whether a SOP occurred on the date of a patient’s admission, and; 2) the proportion of the days in a patient’s stay that had a SOP occur within their trust. These models were adjusted for individual demographic characteristics (age, sex, ethnicity), and recorded comorbidities.ResultsSerious operational problems (SOPs) were common; reported in 47 trusts (52.8%) and were present for 2,701 (of 21,716; 12.4%) trust days. Overall mortality was 37.7% (2,539 deaths). Admission during a period of SOPs was associated with a substantially increased mortality; adjusted odds ratio (OR) 1.34 (95% posterior credible interval (PCI): 1.07 to 1.68). Mortality was also associated with the proportion of a patient’s admission duration that had concurrent SOPs; OR 1.47 (95% PCI: 1.10 to 1.96) for mortality where SOPs were present for 100% compared to 0% of the stay.Conclusion and relevanceSerious operational problems at the trust-level are associated with a significant increase in mortality in patients with COVID-19 admitted to critical care. The link isn’t necessarily causal, but this observation justifies further research to determine if a binary indicator might be a valid prognostic marker for deteriorating quality of care.
Highlights
The emergence of the SARS-Cov-2 pathogen [1], and the new more transmissible variants [2], has resulted in large numbers of people, requiring hospital admission, often to high-acuity critical care settings [3]
Our study shows the declaration of serious operational issues by hospitals appears to be associated with a substantially increased critical care mortality for patients with COVID-19
We demonstrate that declaration of serious operational issues does not reflect hospital occupancy levels, as over 93% of declarations were reported on days when hospitals did not exceed nationally agreed upon occupancy standards and the association was not attenuated after adjustment for ventilated bed occupancy
Summary
The emergence of the SARS-Cov-2 pathogen [1], and the new more transmissible variants [2], has resulted in large numbers of people, requiring hospital admission, often to high-acuity critical care settings [3]. In the UK for example, some hospitals increased their intensive care unit capacity by over 200% at the peak of the first wave of the COVID-19 pandemic to address the increased need [4]. Despite these re-deployed resources, and even in combination with the introduction of non-pharmacological interventions to limit disease transmission [5], many UK hospitals far exceeded the nationally-defined threshold of 85% for safe operating capacity [4]. Staff absence rates were raised 3-fold from the baseline
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