The Effect of Translator Use on Length of Hospital Stay

INTRODUCTION: An impacted population of the COVID-19 pandemic is those with limited English proficiency (LEP). Due to visitor restrictions, caregivers were unable to facilitate communication with hospital staff, and those with LEP were more susceptible to poor communication with their healthcare providers. METHOD(S): Data was ed from the BIDMC site of the SCCM VIRUS Discovery Database, a de-identified, HIPAA-compliant database containing clinical information for COVID-19 patients admitted to BIDMC. Patients were placed into two groups, either requiring translator services for any language or not. Statistical analyses were performed in R Version 3.0 to calculate test statistics such as ANOVA and Chi-Square p-values. The primary outcome assessed length of stay (LOS). Secondary outcomes included complications, discharge status of alive or deceased, discharge location of either home or another care facility, and number of symptomatic days before hospital admission. The association between non-White, non-Hispanic demographics and need for translation services was also examined. RESULT(S): 1522 patients were included with 91 excluded due to unknown use of translator services. The relationship between the requirement of an interpreter and LOS, complications, and symptomatic days was not statistically significant. However, statistically significant findings include patients who required translational services were more likely discharged alive (OR 1.53, 95% CI 1.07-2.24), and discharged to their homes (OR 1.42, 95% CI 1.07-1.91). Use of translator services was strongly associated with minority status (OR 5.20, 95% CI 3.81-7.21). A limitation of this dataset is that deceased status is only recorded if the patient dies during the index visit, potentially missing those who expire from COVID-related complications post-discharge. CONCLUSION(S): The requirement of a translator was not correlated with longer hospital stays, more complications, or days symptomatic prior to admission in comparison to the patients' English-speaking counterparts. However, the use of a translator was positively correlated with survival, discharge home, and minority status. The increased odds of discharge home could be due to the cultural values of minorities providing care in a familial setting.

Covid-19 Icu Admission Disparities among Hispanics and African Americans in Boston

INTRODUCTION: Racism has been identified as a driver of health disparities. The COVID pandemic has widened the gap between Whites and racial minorities, resulting in an even greater burden of disease and poorer health outcomes. The Boston area has a greater wealth disparity between these groups compared to the national average. We hypothesize that African American and Hispanic groups in the Boston Area have carried a greater burden of severe disease compared to Whites. METHOD(S): This cross-sectional study included 1,272 single-event adults admitted to Beth Israel Deaconess Medical Center (Boston, MA) due to COVID from March 2020 to April 2022. Patients were grouped by demographics captured in the medical records. Three groups were determined to have the appropriate sample sizes for analysis: Hispanics of any race, African American Non-Hispanics, and White Non-Hispanics. The primary outcome assessed was ICU admission rates;secondary analyses included length of hospitalized and ICU stay and comorbidity rates. Statistical analyses were performed in R Version 3.0. RESULT(S): Out of our sample, 31% were African American (AA), 20% Hispanic, and 49% White. Compared to Whites, ICU admission rates for AA patients were higher than for Hispanics, with an odds ratio (OR) of 1.45 (95% CI, [1.11,1.91]) and 1.21 [1.27, 1.64], respectively. When adjusting for sex, age, and comorbidities, the same pattern was observed: ICU admission rates for AAs were positively associated for both males (1.64, [1.11,2.43] and females (1.19, [1.04,1.36]), but only for Hispanic females (1.44, [1.05,1.97]). AAs and Hispanics had a significantly higher OR of having 3+ comorbidities (1.3, [1.13,1.72] and 1.47 [1.12, 1.96]). CONCLUSION(S): Ethnic minority groups have suffered a disproportionately greater burden of disease related to COVID. Our study shows that ICU admission was positively associated with AA and Hispanic race, opposite to what had been previously shown in some publications. Our findings could help reorient public health measures to improve health outcomes in these populations.

Assessment of Readmission Risk Factors after Index Hospital Discharge for Covid-19 Patients

INTRODUCTION: During the COVID-19 pandemic, the burden on the healthcare system makes it critical to examine readmission patterns. In this study, we evaluated the readmission rates and risk factors associated with COVID-19 from the large SCCM Discovery VIRUS: COVID-19 Registry. METHOD(S): This was a retrospective, cohort study including hospitalized adult patients from 181 hospitals in 24 countries within the VIRUS: COVID-19 Registry. Demographic, clinical, and outcome data were extracted and divided into two groups: Patients with readmission with COVID-19 in 30 days from discharge and those who were not. A univariate analysis is done using chi-square and t-test as appropriate. Multivariable logistic regression was used to measure risk factor associations with 30-day readmission. RESULT(S): Among 20,283 patients, 1,195 (5.9%) were readmitted within 30 days from discharge. The median (IQR) age of readmitted patients was 66 (55-78) years and 45.2% were female, 60.2% were white, and 78.9% non-Hispanic. Higher odds of readmission were observed in patients aged >60 vs 18-40 years (OR 2.76;95% CI, 2.23-3.41), moderate COVID-19 disease (WHO Ordinal scale 4-5) vs Severe COVID-19 (WHO Ordinal scale 6-9) (OR 1.23;95% CI, 1.10-1.39), no ICU admission at index hospitalization (OR 1.70;95% CI, 1.32-1.80), and Hospital length of stay <=14 vs >14 days (OR 1.53;95% CI, 1.32-1.80) vs those not readmitted (p= < 0.001). Comorbidities including coronary artery disease (OR 2.14;95% CI 1.84-2.48), hypertension (OR 1.58;95% CI 1.40-1.78), congestive Heart Failure (OR 2.54;95% CI 2.16-2.98), chronic pulmonary disease (OR 2.26;95% CI 1.94-2.63), diabetes (OR 1.32;95% CI 1.17-1.49) or chronic kidney disease (CKD) (OR 2.41;95% CI 1.2.09-2.78) were associated with higher odds of readmission. In multivariate logistic regression adjusted for age group, hospital length of stay <=14 days and, highest WHO COVID-19 ordinal scale and index ICU admission coronary artery disease, congestive heart failure, chronic pulmonary disease, chronic kidney disease, hospital length of stay <=14 days and age >60 years remained independent risk factors for readmission within 30 days. CONCLUSION(S): Among hospitalized patients with COVID-19, those readmitted had a higher burden of comorbidities compared to those non-readmitted.

Polypharmacy mediates the effect of mechanical ventilation on incidence of delirium

INTRODUCTION: Delirium in ICU is associated with poor outcomes. Delirium among critically ill COVID-19 patients is due at least in part to iatrogenic causes such as staffing constraints, restricted mobility, and polypharmacy stemming from drug shortages. The aim of this study was to describe the sedation practices and prevalence of delirium at a tertiary level academic medical center. We tested the hypothesis that polypharmacy (PP, use of ≥ 4 classes of sedatives), is a mediator in the causal pathway of mechanical ventilation and delirium. METHODS: 212 patients admitted to ICUs at a tertiary level academic medical center in Boston, MA between Jan 2020 and April 2021 with a primary diagnosis of SARS-CoV2 were included. Mediation analysis was conducted with bootstrap estimation to assess whether association between mechanical ventilation and incidence of delirium was mediated by PP. Analyses were adjusted for potential confounders found to be related to the treatment, mediator, and outcome, including age, gender, vasopressor use, median RASS scores, and maximum CRP levels. RESULTS: Of the 212 patients in the cohort, 72.6% had delirium during their ICU stay, 76.9% were mechanically ventilated, and 54.7% received ≥ 4 classes of sedatives. The percentage of patients given Opioids, Benzodiazepines, Ketamine, Propofol, and Dexmedetomidine, were 81.1%, 60.4%, 40.6%, 75.9%, and 54.3%, respectively. Adjusting for potential confounders, patients given ≥ 4 classes of sedatives had 7.4 (95% CI: 2.5 - 22.4) times the odds of developing delirium compared to those given < 4. Mechanically ventilated patients had 4.9 (95% CI: 1.6 - 15.2) times the odds of developing delirium compared to patients not mechanically ventilated. Approximately 42.1% (95% CI: 39.8 - 50.6) of the mechanical ventilation effect is attributed to the mediation of PP. CONCLUSIONS: Mechanical ventilation is associated with higher risk of delirium and PP mediates > 40% of this effect which is clinically and statistically significant. Prospective studies should explore whether limiting PP among mechanically ventilated patients could reduce delirium.

Hierarchy of values in recovery of respiratory failure: Prospective study of patients and caregivers

BACKGROUND: Survivors of acute respiratory failure (ARF) face challenges that impact their quality of life across multiple domains. This prospective study aims to identify a hierarchy of preferred outcomes by ranking nine domains of recovery, over the period of six months post discharge among patients and their caregivers. METHODS: This is a single-center companion study to the multi-center APICS (Addressing Post Intensive Care Syndrome) study. This protocol has been expanded to enroll a maximum of 80 patient-caregiver dyads at BIDMC including a subset of COVID positive patients. Eligible patients are those who meet ARF criteria in the ICUs at BIDMC for at least 24 hours and are expected to be discharged home are recruited. Patients and caregivers participate in a survey in which they rank 9 aspects of recovery from critical illness from being most important (1) to least important (9). Patients also participate in the MOCA/MOCA-blind questionnaire at baseline and 6-month follow-up. RESULTS: This study is actively enrolling. To date, we have enrolled 21 patients and 5 caregivers. At discharge, 43% of patients ranked survival as most important, while 24% ranked cognitive function as most important. 80% of caregivers ranked survival as most important at discharge. Survival remained the highest priority for patients at 6 months followed by physical, cognitive and pulmonary recovery respectively. CONCLUSIONS: Both survivors and caregivers valued survival as the most important construct of recovery. Cognitive function followed survival as the second most important construct. Preliminary results indicate that these preferences may change over a period of time however small sample size limits broad generalizations. Final results are expected to help delineate a hierarchy of patient centered outcomes in this population.