A new study by Yale researchers found a significant association between the availability of hospital resources. Particularly ICU bed and patient mortality during the early weeks of the COVID-19 pandemic.
It was especially true at hospitals in the northeastern U.S which were hardest hit by the first surge of patient cases, according to the study published in the Journal of Hospital Medicine.
Lead author Dr. Alexander Janke, a Yale emergency scholar in the fourth year of a five – year combined residency and health service research fellowship said” There is a general narrative among people in health care that the more resources there are, the better we can take care of patients. This study begs the question- Are case fatality rate driven by changes in resources?.
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According to their findings, the answer is “yes” in an analysis of 306 hospital referring regions (HRRS) in the U.S from March 1 to July 26, 2020, researchers found that geographic regions with fewer resources per COVID-19 patients including ICU beds, critical care physicians, emergency physicians, nurses and general hospital beds were statistically associated with more deaths in April, 2020. The study looked at 4, 453 hospitals overall.
The strongest association was related to ICU be availability. According to the findings, for every addition ICU bed per COVID-19 cases, there was an associated one-fifth decrease in an incidence rate of death during the month.
According to their estimates, 15,571 COVID-19 patients died at these hospitals due to lack of ICU beds during the month of April, most of the hospital is with greatest numbers of excess deaths were located in the northeast specifically HRRS in New York City, Boston, Philadelphia, Hartford, and Camden N.J . The findings provide important insights as nearly a year later, the country continues to see high rates of COVID-19.
As the country enters one of the darkest periods of the COVID-19 pandemic, with cases and hospitalizations anticipated to continue unabated in the coming months. Dr. Arjun venkatesh associate professor of emergency medicine at Yale school of medicine, a co-author of the study said, “the lesson of this work is clear our hospital resources are finite and a failure to implement the policy to prevent hospital overload is certain to result in deaths that could have been avoided”.
Our paper is a worst-case scenario for what resource limitations might mean for mortality, said Janke. This is a phenomenon that is close to the hearts of everyone in emergency medicine, he added, “sometimes patients have to wait hours or days to get a bed emergency medicine is really good at managing a patient’s first few hours of care, but the department needs to happen”.
Although Janke noted that it may not be with while for a hospital to have excess resources ready in case of a pandemic, he said that there are opportunities for a hospital to engage flexible transactions to accommodate mass illnesses events in the near term. The paper found that after April 2020, the relationship between hospital resources and patient deaths was more muted suggesting that hospitals were able to implement innovation to better manage rising caseloads over time.
Yale New Haven Hospital provided one such existing he said “ Yale was especially successful at mobilising space in the hospital pavilion where the medical ICU in whole floors had to be converted to ICU beds. That required additional staffing, both ICU doctors and nurses, as well as overcoming the logistical challenges of clearing floors and creating new negative pressure (isolation) rooms. Such examples he said can provide important models for other hospital systems as COVID-19 cases again surged across the country.
By: Peace Chigozie