Many Intensive Care Units Were Overloaded While Nearby Hospitals Had Excess Capacity During The COVID-19 Pandemic

Vohra, Adam; Khullar, Dhruv; Kaushal, Rainu; Schpero, William L.

doi:10.1377/hlthaff.2022.01657

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…Third, a recent study found that load imbalance was widespread in the US during the COVID-19 pandemic. 33 Additionally, the study found that hospitals serving high proportions of Medicaid patients and Black Medicare patients tended to be over capacity in regions experiencing load imbalance. Focusing on NYC, our study not only found similar results but further demonstrated the potential adverse impact of load imbalance and critical care strain on health outcomes.…”

Section: Discussionmentioning

confidence: 96%

Hospital segregation, critical care strain, and inpatient mortality during the COVID-19 pandemic in New York City

Zhilkova,

Alsabahi,

Olson

et al. 2023

Preprint

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BackgroundHospital segregation by race, ethnicity, and health insurance coverage is prevalent, with some hospitals providing a disproportionate share of undercompensated care. We assessed whether New York City (NYC) hospitals serving a higher proportion of Medicaid and uninsured patients pre-pandemic experienced greater critical care strain during the first wave of the COVID-19 pandemic, and whether this greater strain was associated with higher rates of in-hospital mortality.MethodsIn a retrospective analysis of all-payer NYC hospital discharge data, we examined changes in admissions and inpatient mortality, stratified by use of intensive care unit (ICU), from the baseline period in early 2020 to the first COVID-19 wave across hospital quartiles (265,329 admissions and 23,032 inpatient deaths), based on the proportion of Medicaid or uninsured admissions from 2017-2019 (quartile 1 lowest to 4 highest). Logistic regressions were used to assess the cross-sectional association between ICU strain, defined as ICU volume in excess of the baseline average, and patient-level mortality.ResultsICU admissions in the first COVID-19 wave were 84%, 97%, 108%, and 123% of the baseline levels by hospital quartile 1-4, respectively. The age-adjusted mortality rates for ICU admissions were 269%, 353%, 375%, and 387%, and those for non-ICU admissions were 355%, 500%, 633%, and 843% of the baseline rates by hospital quartile 1-4, respectively. Compared with the reference group of 100% or less of the baseline weekly average, ICU admissions on a day for which the ICU volume was 101-150%, 151-200%, and > 200% of the baseline weekly average had odds ratio of 1.17 (95% CI=1.10, 1.26), 2.63 (95% CI=2.31, 3.00), and 3.26 (95% CI=2.82, 3.78) for inpatient mortality, and non-ICU admissions on a day for which the ICU volume was 101-150%, 151-200%, and > 200% of the baseline weekly average had odds ratio of 1.28 (95% CI=1.22, 1.34), 2.60 (95% CI=2.40, 2.82), and 3.44 (95% CI=3.11, 3.63) for inpatient mortality.ConclusionsOur findings are consistent with hospital segregation as a potential driver of COVID-related mortality inequities and highlight the need to desegregate health care to address structural racism, advance health equity, and improve pandemic resiliency.

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Section: Discussionmentioning

confidence: 96%

Hospital segregation, critical care strain, and inpatient mortality during the COVID-19 pandemic in New York City

Zhilkova,

Alsabahi,

Olson

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Consistent with an analysis conducted by Kadri et al [ 26 ], we found that strained ICU capacity may be associated with worse outcomes among non-ICU patients, suggesting the importance of including both ICU and non-ICU outcomes in assessing the impact of critical care strain. Third, a recent study found that load imbalance was widespread in the US during the COVID-19 pandemic [ 33 ]. Additionally, the study found that hospitals serving high proportions of Medicaid patients and Black Medicare patients tended to be over capacity in regions experiencing load imbalance.…”

Section: Discussionmentioning

confidence: 99%

Hospital segregation, critical care strain, and inpatient mortality during the COVID-19 pandemic in New York City

Zhilkova,

Alsabahi,

Olson

et al. 2024

PLoS ONE

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Background Hospital segregation by race, ethnicity, and health insurance coverage is prevalent, with some hospitals providing a disproportionate share of undercompensated care. We assessed whether New York City (NYC) hospitals serving a higher proportion of Medicaid and uninsured patients pre-pandemic experienced greater critical care strain during the first wave of the COVID-19 pandemic, and whether this greater strain was associated with higher rates of in-hospital mortality. Methods In a retrospective analysis of all-payer NYC hospital discharge data, we examined changes in admissions, stratified by use of intensive care unit (ICU), from the baseline period in early 2020 to the first COVID-19 wave across hospital quartiles (265,329 admissions), and crude and risk-adjusted inpatient mortality rates, also stratified by ICU use, in the first COVID wave across hospital quartiles (23,032 inpatient deaths), based on the proportion of Medicaid or uninsured admissions from 2017–2019 (quartile 1 lowest to 4 highest). Logistic regressions were used to assess the cross-sectional association between ICU strain, defined as ICU volume in excess of the baseline average, and patient-level mortality. Results ICU admissions in the first COVID-19 wave were 84%, 97%, 108%, and 123% of the baseline levels by hospital quartile 1–4, respectively. The risk-adjusted mortality rates for ICU admissions were 36.4 (CI = 34.7,38.2), 43.6 (CI = 41.5,45.8), 45.9 (CI = 43.8,48.1), and 45.7 (CI = 43.6,48.0) per 100 admissions, and those for non-ICU admissions were 8.6 (CI = 8.3,9.0), 10.9 (CI = 10.6,11.3), 12.6 (CI = 12.1,13.0), and 12.1 (CI = 11.6,12.7) per 100 admissions by hospital quartile 1–4, respectively. Compared with the reference group of 100% or less of the baseline weekly average, ICU admissions on a day for which the ICU volume was 101–150%, 151–200%, and > 200% of the baseline weekly average had odds ratios of 1.17 (95% CI = 1.10, 1.26), 2.63 (95% CI = 2.31, 3.00), and 3.26 (95% CI = 2.82, 3.78) for inpatient mortality, and non-ICU admissions on a day for which the ICU volume was 101–150%, 151–200%, and > 200% of the baseline weekly average had odds ratios of 1.28 (95% CI = 1.22, 1.34), 2.60 (95% CI = 2.40, 2.82), and 3.44 (95% CI = 3.11, 3.63) for inpatient mortality. Conclusions Our findings are consistent with hospital segregation as a potential driver of COVID-related mortality inequities and highlight the need to desegregate health care to address structural racism, advance health equity, and improve pandemic resiliency.

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“…Stanford Health Care has experienced major changes in operations during the COVID-19 era, a challenging period coincident with major infrastructure changes from opening a second hospital and a “halo” effect from Stanford Health Care's outsized role during the pandemic. 13 Moreover, many local and regional hospitals in the San Francisco Bay Area struggled during this period with adequately staffing hospital beds producing more demand on Stanford Health Care which were not severely affected by nursing staffing or lab supplies shortages. Stanford had ongoing recruitment and relationships with other labs and hospitals to secure supplies.…”

Section: Discussionmentioning

confidence: 99%

Intra- and post-pandemic impact of the COVID-19 outbreak on Stanford Health Care

Phongpreecha,

Berson,

Xue

et al. 2024

Academic Pathology

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Many Intensive Care Units Were Overloaded While Nearby Hospitals Had Excess Capacity During The COVID-19 Pandemic

Cited by 6 publications

References 22 publications

Hospital segregation, critical care strain, and inpatient mortality during the COVID-19 pandemic in New York City

Hospital segregation, critical care strain, and inpatient mortality during the COVID-19 pandemic in New York City

Hospital segregation, critical care strain, and inpatient mortality during the COVID-19 pandemic in New York City

Intra- and post-pandemic impact of the COVID-19 outbreak on Stanford Health Care

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