Mortality among people admitted to Australian intensive care units for reasons other than COVID‐19 during the COVID‐19 pandemic: a retrospective cohort study

Abstract

Objective To investigate in‐hospital mortality among people admitted to Australian intensive care units (ICUs) with conditions other than coronavirus disease 2019 (COVID‐19) during the COVID‐19 pandemic. Design National, multicentre, retrospective cohort study; analysis of data in the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS CORE) Adult Patient Database. Setting, participants Adults (16 years or older) without COVID‐19 admitted to Australian ICUs, 1 January 2016 – 30 June 2022. Main outcome measures All‐cause in‐hospital mortality, unadjusted and relative to the January 2016 value, adjusted for illness severity (Australian and New Zealand Risk of Death [ANZROD] and hospital type), with ICU as a random effect. Points of change in mortality trends (breakpoints) were identified by segmental regression analysis. Results Data for 950 489 eligible admissions to 186 ICUs were available. In‐hospital mortality declined steadily from January 2016 to March 2021 by 0.3% per month (P < 0.001; March 2021 v January 2016: adjusted odds ratio [aOR], 0.70; 95% confidence interval [CI], 0.62–0.80), but rose by 1.4% per month during March 2021 – June 2022 (P < 0.001; June 2022 v January 2016: aOR, 1.03; 95% CI, 0.90–1.17). The rise in mortality continued after the number of COVID‐19‐related ICU admissions had declined; mortality increased in jurisdictions with lower as well as in those with higher numbers of COVID‐19‐related ICU admissions. Conclusion The rise in in‐hospital mortality among people admitted to Australian ICUs with conditions other than COVID‐19 from March 2021 reversed the improvement of the preceding five years. Changes to health service delivery during the pandemic and their consequences should be investigated further.

The impact of nursing workforce skill-mix on patient outcomes in intensive care units in Victoria, Australia

“…Our study raises the possibility that inadequate numbers of critical care trained nurses may have contributed to excess mortality during the pandemic and also potentially to the ongoing reversal of the annual reduction in mortality presently reported in Australian ICUs. 24 , 31 The consistency of our findings after adjusting for the ICU Activity index, which is a measure of overall ICU strain combining patient acuity and staffing, suggests that the skill-mix itself is an independent factor influencing patient outcomes which goes beyond the absolute number of nursing staff available and the overall acuity of the ICU. Our finding that CCRN skill-mix was not associated with outcomes in those who did not receive invasive ventilation, renal replacement or ECMO, has important implications to the allocation of nurse staffing.…”

“…Excluding patients admitted for COVID-19, the all-cause mortality has increased in Australian ICUs for the first time in five years. 24 The COVID-19 pandemic required an adaptable nursing workforce with nursing redeployment, rapid upskilling and changed models of staffing. 13 The COVID-19 pandemic impacted health and healthcare delivery, with workforce shortages, especially in critical care environments continuing to be a global challenge for healthcare systems.…”

Sepsis mortality among patients with haematological malignancy admitted to intensive care 2000–2022: a binational cohort study

“…The impact of the SARS-CoV-2 pandemic on non-SARS-CoV-2 mortality has also been previously described and may relate to increased strain on hospital and ICU systems [ 26 ]. A large population based study in the United States described increased non-SARS-CoV-2 mortality in 2020–2021, with the greatest impact in hospitals with highest prevalence of SARS-CoV-2 [ 27 ].…”