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A national retrospective study of the association between serious operational problems and COVID-19 specific intensive care mortality risk.
Wilde, Harrison; Dennis, John M; McGovern, Andrew P; Vollmer, Sebastian J; Mateen, Bilal A.
Afiliação
  • Wilde H; Department of Statistics, University of Warwick, Coventry, United Kingdom.
  • Dennis JM; Institute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, United Kingdom.
  • McGovern AP; Institute of Biomedical & Clinical Science, University of Exeter Medical School, Exeter, United Kingdom.
  • Vollmer SJ; Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom.
  • Mateen BA; Department of Statistics, University of Warwick, Coventry, United Kingdom.
PLoS One ; 16(7): e0255377, 2021.
Article em En | MEDLINE | ID: mdl-34324569
ABSTRACT

OBJECTIVES:

To describe the relationship between reported serious operational problems (SOPs), and mortality for patients with COVID-19 admitted to intensive care units (ICUs).

DESIGN:

English national retrospective cohort study.

SETTING:

89 English hospital trusts (i.e. small groups of hospitals functioning as single operational units). PATIENTS All adults with COVID-19 admitted to ICU between 2nd April and 1st December, 2020 (n = 6,737).

INTERVENTIONS:

N/A. MAIN OUTCOMES AND

MEASURES:

Hospital 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.

RESULTS:

Serious 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 RELEVANCE Serious 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.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: COVID-19 Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: PLoS One Assunto da revista: CIENCIA / MEDICINA Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Reino Unido

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: COVID-19 Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: PLoS One Assunto da revista: CIENCIA / MEDICINA Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Reino Unido