Wilde, Harrison;
Dennis, John M;
McGovern, Andrew P;
Vollmer, Sebastian J;
Mateen, Bilal A;
(2021)
A national retrospective study of the association between serious operational problems and COVID-19 specific intensive care mortality risk.
PLoS ONE
, 16
(7)
, Article e0255377. 10.1371/journal.pone.0255377.
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Abstract
Objectives: To describe the relationship between reported serious operational problems (SOPs), and mortality for patients with COVID-19 admitted to intensive care units (ICUs). // Design: English national retrospective cohort study. // Setting: 89 English hospital trusts (i.e. small groups of hospitals functioning as single operational units). // Patients: All adults with COVID-19 admitted to ICU between 2nd April and 1st December, 2020 (n = 6,737). // Interventions: N/A // Main outcomes and measures: Hospital trusts routinely submit declarations of whether they have experienced ‘serious operational problems’ in the last 24 hours (e.g. due to staffing issues, adverse weather conditions, etc.). Bayesian hierarchical models were used to estimate the association between in-hospital mortality (binary outcome) and: 1) an indicator for whether a SOP occurred on the date of a patient’s admission, and; 2) the proportion of the days in a patient’s stay that had a SOP occur within their trust. These models were adjusted for individual demographic characteristics (age, sex, ethnicity), and recorded comorbidities. // Results: Serious operational problems (SOPs) were common; reported in 47 trusts (52.8%) and were present for 2,701 (of 21,716; 12.4%) trust days. Overall mortality was 37.7% (2,539 deaths). Admission during a period of SOPs was associated with a substantially increased mortality; adjusted odds ratio (OR) 1.34 (95% posterior credible interval (PCI): 1.07 to 1.68). Mortality was also associated with the proportion of a patient’s admission duration that had concurrent SOPs; OR 1.47 (95% PCI: 1.10 to 1.96) for mortality where SOPs were present for 100% compared to 0% of the stay. // Conclusion and relevance: Serious operational problems at the trust-level are associated with a significant increase in mortality in patients with COVID-19 admitted to critical care. The link isn’t necessarily causal, but this observation justifies further research to determine if a binary indicator might be a valid prognostic marker for deteriorating quality of care.
| Type: | Article |
|---|---|
| Title: | A national retrospective study of the association between serious operational problems and COVID-19 specific intensive care mortality risk |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1371/journal.pone.0255377 |
| Publisher version: | http://dx.doi.org/10.1371/journal.pone.0255377 |
| Language: | English |
| Additional information: | Copyright © 2021 Wilde et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, https://creativecommons.org/licenses/by/4.0/,which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics > Clinical Epidemiology |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10184689 |
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