1 in 5 COVID deaths potentially attributable to hospital caseload strain

1 in 5 COVID deaths potentially attributable to hospital caseload strain

Abstract: https://www.acpjournals.org/doi/10.7326/M24-0869

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A nationwide retrospective cohort study evaluated the effect of COVID-19 caseload stress on the probability of in-hospital mortality or discharge to hospice. The data revealed a detrimental relationship between COVID-19 caseload and survival across all hospital types, far beyond the pandemic’s learning curve. The study is published in Annals of Internal Medicine.

Researchers from the National Institutes of Health Clinical Center studied data from inpatient encounters of adults with COVID-19 at 620 US hospitals during the Delta wave surges between July 1 and November 21, 2021. The goal was to determine whether hospitals’ care infrastructure, ICU types, and native bed capacity influenced the care quality during hospital stress and staffing shortages. The primary exposure variable to the data was COVID-19 surge index, a metric for strain separated into percentiles, which includes all patients hospitalized with COVID-19 and adjusted for patient severity and baseline bed capacity the Delta variant phase. The study classified hospitals into mutually exclusive groups to organize their types and levels of infrastructure. To account for potential confounding factors and improve findings’ validity and accuracy, the study incorporated many patient-, hospital-, and community-level covariates. Through statistical, exploratory, and sensitivity analysis, researchers found that caseload strain remained substantially detrimental to survival in patients with COVID-19 across hospitals, regardless of hospital size, location, or resource complexity. Approximately 1 in every 5 COVID-19 deaths were attributable to hospital caseload strain.

According to the authors, this is the first study to examine the effect of hospital type and infrastructure on the care quality for COVID-19 amid caseload stress. The findings provide hypothesis-generating insights for the ongoing staff shortage crisis in U.S. hospitals and heighten the importance of minimizing caseload surge during future public health emergencies. The researchers conclude that avoiding surging caseload might be lifesaving.

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected]. To speak with corresponding author Sameer S. Kadri, MD, MS, please email [email protected].