Strain on Scarce Intensive Care Beds Drives Reduced Patient Volumes, Patient Selection, and Worse Outcome: A National Cohort Study DOI
Sylvia Brinkman, Nicolette F. de Keizer, Dylan W. de Lange

и другие.

Critical Care Medicine, Год журнала: 2023, Номер 52(4), С. 574 - 585

Опубликована: Дек. 14, 2023

OBJECTIVES: Strain on ICUs during the COVID-19 pandemic required stringent triage at ICU to distribute resources appropriately. This could have resulted in reduced patient volumes, selection, and worse outcome of non-COVID-19 patients, especially peaks when strain was extreme. We analyzed this potential impact patients. DESIGN: A national cohort study. SETTING: Data 71 Dutch PARTICIPANTS: total 120,393 patients (from March 1, 2020 February 28, 2022) 164,737 prepandemic January 2018 December 31, 2019). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Volume, characteristics, mortality were compared between cohort, focusing period its peaks, with attention strata specific admission types, diagnoses, severity. The number admitted were, respectively, 26.9% 34.2% lower cohort. consisted fewer medical (48.1% vs. 50.7%), comorbidities (36.5% 40.6%), more mechanical ventilation (45.3% 42.4%) vasoactive medication (44.7% 38.4%) Case-mix adjusted higher period, odds ratios 1.08 (95% CI, 1.05–1.11) 1.10 1.07–1.13). CONCLUSIONS: In healthcare has driven volume, selection comorbid who intensive support, a modest increase case-mix mortality.

Язык: Английский

Measures and Impact of Caseload Surge During the COVID-19 Pandemic: A Systematic Review* DOI
Maniraj Neupane,

Nathaniel De Jonge,

Sahil Angelo

и другие.

Critical Care Medicine, Год журнала: 2024, Номер 52(7), С. 1097 - 1112

Опубликована: Март 22, 2024

COVID-19 pandemic surges strained hospitals globally. We performed a systematic review to examine measures of caseload surge and its impact on mortality hospitalized patients.

Язык: Английский

Процитировано

10

Clinical evaluation of a machine learning–based early warning system for patient deterioration DOI Creative Commons
Amol A. Verma, Thérèse A. Stukel, Michael Colacci

и другие.

Canadian Medical Association Journal, Год журнала: 2024, Номер 196(30), С. E1027 - E1037

Опубликована: Сен. 15, 2024

The implementation and clinical impact of machine learning-based early warning systems for patient deterioration in hospitals have not been well described. We sought to describe the evaluation a multifaceted, real-time, system used general internal medicine (GIM) unit an academic medical centre.

Язык: Английский

Процитировано

6

Mortality for Time-Sensitive Conditions at Urban vs Rural Hospitals During the COVID-19 Pandemic DOI Creative Commons
Hui Jiang, Rachel Mosher Henke, Kathryn R. Fingar

и другие.

JAMA Network Open, Год журнала: 2024, Номер 7(3), С. e241838 - e241838

Опубликована: Март 12, 2024

Importance COVID-19 pandemic-related disruptions to the health care system may have resulted in increased mortality for patients with time-sensitive conditions. Objective To examine whether in-hospital hospitalizations not related (non–COVID-19 stays) conditions changed during pandemic and how it varied by hospital urban vs rural location. Design, Setting, Participants This cohort study was an interrupted time-series analysis assess (March 8, 2020, December 31, 2021) compared prepandemic period (January 1, 2017, March 7, 2020) overall, month, community transmission level adult discharges from 3813 US hospitals State Inpatient Databases Healthcare Cost Utilization Project. Exposure The pandemic. Main Outcomes Measures main outcome measure among non–COVID-19 stays 6 medical conditions: acute myocardial infarction, hip fracture, gastrointestinal hemorrhage, pneumonia, sepsis, stroke. Entropy weights were used align patient characteristics 2 time periods age, sex, comorbidities. Results There 18 601 925 hospitalizations; 50.3% of male, 38.5% aged 64 years, 45.0% 65 84 16.4% 85 years or older selected 2017 through 2021. odds sepsis 27% at (odds ratio [OR], 1.27; 95% CI, 1.25-1.29) 35% (OR, 1.35; 1.30-1.40). In-hospital pneumonia had similar increases 1.48; 1.42-1.54) 1.46; 1.36-1.57) hospitals. Increases these showed a dose-response association (low high burden) both (sepsis: 22% 54%; pneumonia: 30% 66%) 16% 28%; 34% 61%) infarction 9% 1.09; 1.06-1.12) responsive level. significant fracture 1.32; 1.14-1.53) hemorrhage 1.15; 1.09-1.21). No change found stroke overall. Conclusions Relevance In this study, Mobilizing strategies tailored different needs help reduce likelihood excess deaths future public crises.

Язык: Английский

Процитировано

4

Direct Health Care Costs Associated with Asthma Hospitalizations Before and During the Covid-19 Pandemic in the United States: A Nationwide Inpatient Sample Analysis. DOI Open Access
N. Solanki,

B.F. Fakhry,

P. Zhang

и другие.

medRxiv (Cold Spring Harbor Laboratory), Год журнала: 2025, Номер unknown

Опубликована: Янв. 10, 2025

Abstract Background Asthma, a chronic inflammatory airway disorder, can increase the risk of hospitalizations in individuals with viral infections such as COVID-19. The impact COVID-19 pandemic on asthma-related United States remains unknown. Objective We hypothesized that led to an economic burden society and decrease hospitalization rates for asthma. Methods analyzed weighted data from National Inpatient Sample (NIS) between January 1, 2018, December 31, 2020. outcomes were asthma rates, length stay (LOS), in-hospital mortality hospital admission costs. Results More people admitted primary diagnosis 2018 2019 compared 2020 (hospitalization rate per 100,000: 2018: 38.6 versus (vs) 2019:37.0 vs 2020: 21.4; P <0.001). Hospital costs increased (2018: median [IQR] 5,251 [ 3,426, 8,278]; 2019:5,677 [3,725, 8.969]; 5,881 [3,920-9,216]; Additionally, in-patient slightly 2020, rising 0.44%, 0.20% 0.30% (P When comparing geographic divisions, mid-Atlantic division had highest Pacific 2018-2020 <0.05). Conclusion Asthma decreased previous years. Those during higher significantly This investigation provides valuable insights policy makers about shifts healthcare utilization pandemic.

Язык: Английский

Процитировано

0

Reducing Hospitalisations With a Skin and Soft Tissue Infection Clinic DOI Creative Commons

Tarek Abdelhalim,

Naudea Mair,

Sherele McGhie

и другие.

Journal of Evaluation in Clinical Practice, Год журнала: 2025, Номер 31(3)

Опубликована: Апрель 1, 2025

ABSTRACT Rationale Patients with skin and soft tissue infection are often admitted to hospital despite compelling evidence that many can be managed safely as outpatients. This quality improvement study reports the outcomes of an outpatient programme implemented at academic acute‐care in Toronto, Canada. Methods The intervention was care pathway for patients suspected who may otherwise have required admission hospital. within existing general internal medicine clinic primarily involved addition part‐time advanced practice wound nurses. main outcome number inpatient days infection. Data were analysed 4 years pre‐intervention (June 2016–May 2020) 2 post‐intervention 2020–May 2022). Another same network which did not undergo included a control. Results During 2‐year period there 465 visits (mean 19/month). median decreased from 224 per month before 148 after (a reduction 34%). There no control site or among all diagnoses site. Conclusions implementation associated sustained 34% demonstrates benefits enhancing through creation streamlined adding interdisciplinary expertise.

Язык: Английский

Процитировано

0

Policy Proposals for Mitigating Intensive Care Unit Strain: Insights from the COVID-19 Pandemic DOI
Ivor S. Douglas, Anuj B. Mehta, Jason Mansoori

и другие.

Annals of the American Thoracic Society, Год журнала: 2024, Номер 21(12), С. 1633 - 1642

Опубликована: Сен. 5, 2024

Intensive care unit (ICU) strain, characterized by a discrepancy between perceived or actual intensive resources and demand, significantly impacts patient outcomes healthcare worker well-being. The coronavirus disease (COVID-19) pandemic exacerbated ICU leading to increased mortality extended hospital stays, affecting both critically ill patients with without COVID-19. A systematic review identified 16 lagging indicators of capacity including queuing, premature after-hours discharge, use temporary space, length stay, burnout, staffing nurse-to-patient ratio, census, acuity turnover, standardized readmissions, availability critical supplies, ventilator use, surgery cancellation. However, variability in operational definitions limited evidence regarding the reliability, validity, usability, feasibility limit value single for informed strategic planning policy guidance. Regional national policies programs are essential enhance real-time monitoring effective management resources, they mitigate impact facilitating complex interhospital transfers reduce strain ensuring comprehensive strategies enhancing resilience. Proactive regional cooperation is advocated formulation, knowledge exchange, resource allocation anticipate equitable access during global health crises. implications future preparedness emphasize importance evidence-based triage adaptable alongside ethical considerations role behavioral economic insights optimizing utilization collaborative practices. This multifaceted approach addressing comprehensively effectively would promote equity system resilience under routine operations crisis conditions.

Язык: Английский

Процитировано

2

Trends in heart failure-related mortality among middle-aged adults in the United States from 1999-2022 DOI Creative Commons
Ali Bin Abdul Jabbar,

M. Le May,

McKayla Deisz

и другие.

Current Problems in Cardiology, Год журнала: 2024, Номер unknown, С. 102973 - 102973

Опубликована: Дек. 1, 2024

Язык: Английский

Процитировано

2

Strain on Scarce Intensive Care Beds Drives Reduced Patient Volumes, Patient Selection, and Worse Outcome: A National Cohort Study DOI
Sylvia Brinkman, Nicolette F. de Keizer, Dylan W. de Lange

и другие.

Critical Care Medicine, Год журнала: 2023, Номер 52(4), С. 574 - 585

Опубликована: Дек. 14, 2023

OBJECTIVES: Strain on ICUs during the COVID-19 pandemic required stringent triage at ICU to distribute resources appropriately. This could have resulted in reduced patient volumes, selection, and worse outcome of non-COVID-19 patients, especially peaks when strain was extreme. We analyzed this potential impact patients. DESIGN: A national cohort study. SETTING: Data 71 Dutch PARTICIPANTS: total 120,393 patients (from March 1, 2020 February 28, 2022) 164,737 prepandemic January 2018 December 31, 2019). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Volume, characteristics, mortality were compared between cohort, focusing period its peaks, with attention strata specific admission types, diagnoses, severity. The number admitted were, respectively, 26.9% 34.2% lower cohort. consisted fewer medical (48.1% vs. 50.7%), comorbidities (36.5% 40.6%), more mechanical ventilation (45.3% 42.4%) vasoactive medication (44.7% 38.4%) Case-mix adjusted higher period, odds ratios 1.08 (95% CI, 1.05–1.11) 1.10 1.07–1.13). CONCLUSIONS: In healthcare has driven volume, selection comorbid who intensive support, a modest increase case-mix mortality.

Язык: Английский

Процитировано

3