A critical care outreach team under strain – Evaluation of the service provided to patients with haematological malignancy during the Covid-19 pandemic

Prower, Emma; Hadfield, Sophie; Saha, Rohit; Woo, Timothy; Ang, Kar Mun; Metaxa, Victoria

doi:10.1016/j.jcrc.2022.154109

Cited by 1 publication

(5 citation statements)

References 42 publications

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“…The evidence base expanded over the course of the pandemic, with 1 included study published in 2020, 17 in each of 2021 and 2022, and 4 published in 2023. Most (n = 33; 85%) were retrospective observational studies, four were prospective cohort studies (13)(14)(15)(16), one was a point-prevalence study (17), and one was a mixed-method study (18).…”

Section: Resultsmentioning

confidence: 99%

“…Studies included patients' data from as early as January 2020 (5,15) until March 2022 (19)(20)(21). Most (19) were multicentric, 14 used nationwide data (one with 4626 hospitals) (22) and the remaining 6 were single-center studies (16,18,(23)(24)(25)(26). Thirty-five studies (90%) originated from HIC while only three (8%) were from LMIC (Brazil [27], Mexico [16], and South Africa [14]), and the remaining one was a global study (17) involving 280 ICUs from 46 countries (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Four studies indirectly reflected the effects of increased caseloads (6, 17, 18, 42). These indirect caseload metrics included altered staffing ratios (6, 17), or the creation of alternative care areas such as supplemental ICUs to accommodate high caseloads (17).…”

Section: Resultsmentioning

confidence: 99%

“…Another study showed mixed effects, with increased COVID-19 admissions increasing mortality odds while higher MV bed occupancy decreasing it (38). The study by Prower et al (18) suggested that during the surge, the expanded critical care outreach team attended to patients faster, resulting in fewer ICU admissions and no difference in mortality. Another study from Canada that used severity weighted index did not report worse outcomes for all non-COVID-19 patients in the study but highlighted caseload as detrimental to subset of patients with heart failure, chronic obstructive pulmonary disease, and asthma, those conditions that share COVID-19 management resources such as ventilators or ICUs (47).…”

Section: Discussionmentioning

confidence: 99%

“…Surge was associated with higher mortality in 32 of 39 studies (82%), including 26 of 31 COVID-19 studies (84%), 4 of 6 non-COVID-19 studies (67%), and 2 of 2 studies that included patients with and without COVID-19. Notably, seven studies (18%) (one using composite metric, three using occupancy, and the remaining three using indirect caseload metrics) reported no impact on mortality with caseload surge (eTable 5, http://links.lww.com/CCM/H520) (6,17,18,37,38,47,35). Only one (25%) of four studies using indirect caseload metrics reported worse survival with surge (42).…”

Section: Surge-mortality Relationship Across Caseload-based Studiesmentioning

confidence: 99%

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

Neupane,

De Jonge,

Angelo

et al. 2024

Critical Care Medicine

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Objectives: COVID-19 pandemic surges strained hospitals globally. We performed a systematic review to examine measures of pandemic caseload surge and its impact on mortality of hospitalized patients. Data Sources: PubMed, Embase, and Web of Science. Study Selection: English-language studies published between December 1, 2019, and November 22, 2023, which reported the association between pandemic “surge”-related measures and mortality in hospitalized patients. Data Extraction: Three authors independently screened studies, extracted data, and assessed individual study risk of bias. We assessed measures of surge qualitatively across included studies. Given multidomain heterogeneity, we semiquantitatively aggregated surge–mortality associations. Data Synthesis: Of 17,831 citations, we included 39 studies, 17 of which specifically described surge effects in ICU settings. The majority of studies were from high-income countries (n = 35 studies) and included patients with COVID-19 (n = 31). There were 37 different surge metrics which were mapped into four broad themes, incorporating caseloads either directly as unadjusted counts (n = 11), nested in occupancy (n = 14), including additional factors (e.g., resource needs, speed of occupancy; n = 10), or using indirect proxies (e.g., altered staffing ratios, alternative care settings; n = 4). Notwithstanding metric heterogeneity, 32 of 39 studies (82%) reported detrimental adjusted odds/hazard ratio for caseload surge–mortality outcomes, reporting point estimates of up to four-fold increased risk of mortality. This signal persisted among study subgroups categorized by publication year, patient types, clinical settings, and country income status. Conclusions: Pandemic caseload surge was associated with lower survival across most studies regardless of jurisdiction, timing, and population. Markedly variable surge strain measures precluded meta-analysis and findings have uncertain generalizability to lower-middle-income countries (LMICs). These findings underscore the need for establishing a consensus surge metric that is sensitive to capturing harms in everyday fluctuations and future pandemics and is scalable to LMICs.

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