Patient characteristics, clinical care, resource use, and outcomes associated with hospitalization for COVID-19 in the Toronto area

Verma, Amol A.; Hora, Tejasvi; Jung, Hae Young; Fralick, Michael; Małecki, S; Lapointe‐Shaw, Lauren; Weinerman, Adina; Tang, Terence; Kwan, Janice; Liu, Jessica J.; Rawal, Shail; Chan, Timothy C. Y.; Cheung, Angela M.; Rosella, Laura; Ghassemi, Marzyeh; Herridge, Margaret S.; Mamdani, Muhammad; Razak, Fahad

doi:10.1101/2020.12.15.20248199

Cited by 1 publication

(5 citation statements)

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“…General internal medicine wards care for nearly 40% of patients admitted from the emergency department at these hospitals. 19 In accordance with the previous study, 15 we hypothesized that the recognition or risk of critical illness as defined by ICU transfer or death would be greater after a critical illness event occurred on the same ward. We sought to confirm this finding, strengthen the investigation of potential causality with a "negative control" analysis, and provide preliminary insights into potential explanations for the association.…”

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confidence: 62%

“…The need for informed patient consent was waived by the board because this was a large, retrospective database study. Hospitals were participating in the General Medicine Inpatient Initiative (GEMINI) research collaborative, 19 which collected data about all GIM hospitalizations. The GIM services at these hospitals include teaching services involving undergraduate and postgraduate trainees and a small number of nonteaching teams.…”

Section: Design Setting and Participantsmentioning

confidence: 99%

“…The GIM services at these hospitals include teaching services involving undergraduate and postgraduate trainees and a small number of nonteaching teams. 19 All hospitals have on-site intensivist-led ICUs and ICU rapid response teams for deteriorating patients on the ward. Nurse to patient ratios on GIM wards ranged between 1:4 and 1:6, depending on staff availability, patient volume, and time of day.…”

Section: Design Setting and Participantsmentioning

confidence: 99%

“…GEMINI 19,20 collects administrative health data from hospitals as reported to the Canadian Institute for Health Information and electronic clinical data extracted from hospital information systems. Manual validation of 3300 hospitalizations determined that the sensitivity and positive predictive value of extracted data in GEMINI for transfer to the ICU were 100% and 96%, respectively, and for death were 100% and 100%, respectively.…”

Section: Data Collectionmentioning

confidence: 99%

“…Among patients transferred to the ICU, LAPS values at admission appeared somewhat lower for those exposed to more than 1 prior event (median score, 19 [IQR,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]) compared with the other groups (median score for those exposed to 1 event, 20 [IQR, ; median score for those exposed to 0 events, 23 [IQR, 12-37]) (eTable 1 in Supplement 1). An ICU transfer occurred more often at night after exposures (1600 of 3179 patients [50.3%] unexposed, 410 of 656 [62.5%] exposed to 1 event, and 141 of 227 [62.1%] exposed to >1 event).…”

Section: Characteristics Of Events Across Exposure Categoriesmentioning

confidence: 99%

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Temporal Clustering of Critical Illness Events on Medical Wards

et al. 2023

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ImportanceRecognizing and preventing patient deterioration is important for hospital safety.ObjectiveTo investigate whether critical illness events (in-hospital death or intensive care unit [ICU] transfer) are associated with greater risk of subsequent critical illness events for other patients on the same medical ward.Design, Setting, and ParticipantsRetrospective cohort study in 5 hospitals in Toronto, Canada, including 118 529 hospitalizations. Patients were admitted to general internal medicine wards between April 1, 2010, and October 31, 2017. Data were analyzed between January 1, 2020, and April 10, 2023.ExposuresCritical illness events (in-hospital death or ICU transfer).Main Outcomes and MeasuresThe primary outcome was the composite of in-hospital death or ICU transfer. The association between critical illness events on the same ward across 6-hour intervals was studied using discrete-time survival analysis, adjusting for patient and situational factors. The association between critical illness events on different comparable wards in the same hospital was measured as a negative control.ResultsThe cohort included 118 529 hospitalizations (median age, 72 years [IQR, 56-83 years]; 50.7% male). Death or ICU transfer occurred in 8785 hospitalizations (7.4%). Patients were more likely to experience the primary outcome after exposure to 1 prior event (adjusted odds ratio [AOR], 1.39; 95% CI, 1.30-1.48) and more than 1 prior event (AOR, 1.49; 95% CI, 1.33-1.68) in the prior 6-hour interval compared with no exposure. The exposure was associated with increased odds of subsequent ICU transfer (1 event: AOR, 1.67; 95% CI, 1.54-1.81; &gt;1 event: AOR, 2.05; 95% CI, 1.79-2.36) but not death alone (1 event: AOR, 1.08; 95% CI, 0.97-1.19; &gt;1 event: AOR, 0.88; 95% CI, 0.71-1.09). There was no significant association between critical illness events on different wards within the same hospital.Conclusions and RelevanceFindings of this cohort study suggest that patients are more likely to be transferred to the ICU in the hours after another patient’s critical illness event on the same ward. This phenomenon could have several explanations, including increased recognition of critical illness and preemptive ICU transfers, resource diversion to the first event, or fluctuations in ward or ICU capacity. Patient safety may be improved by better understanding the clustering of ICU transfers on medical wards.

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mentioning

confidence: 62%

Section: Design Setting and Participantsmentioning

confidence: 99%

Section: Design Setting and Participantsmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%