Strain from hospital caseloads played a role in one in five COVID-19 deaths, even after facilities had weathered and learned from earlier virus waves, researchers based at the US National Institutes of Health Clinical Center reported today.
One of their goals was to examine if fatal outcomes for COVID patients varied by different hospital types, from larger, more advanced facilities to smaller hospitals. Reporting in the Annals of Internal Medicine, they found that high caseloads had a negative impact on survival across all four hospital types they looked at.
Using information from a large database of hospitals, they analyzed COVID patient load and outcomes at 620 hospitals during the Delta variant wave, which occurred from June to December 2021. The team classified hospitals into four types: extracorporeal membrane oxygenation (ECMO) capable, ones with multiple intensive care units (ICUs), facilities with a single large ICU, and those with one small ICU.
They also used a validated surge index that factored in severity of COVID caseload relative to hospital bed capacity. They examined how the surges affected hospital deaths and discharges to hospice.
Impact seen across all facility types
Despite improvements in patient care by the time the Delta wave hit, the probability of death rose 5.51% (95% confidence interval, 4.53% to 6.50%) per surge index unit increase, which suggests that the workload strain was a contributing factor in one in five COVID deaths.
The authors noted that the findings held steady across the four facility types, even when adjusting for factors such as patient transfers. They said their investigation is the first to examine the effect of hospital type and infrastructure on the quality of care for COVID patients amid caseload stress.
These findings underscore the importance of strategic redistribution of patients between hospitals during public health emergencies.
Study findings yield insights for ongoing staff shortages at US hospitals and underscore the importance of minimizing caseload surges during future public health crises.
"These findings underscore the importance of strategic redistribution of patients between hospitals during public health emergencies, including routine surges, so U.S. hospitals already struggling amid staffing crisis have mechanisms for decompression and personnel redistribution," the group wrote.
