Danielle Stansky, MD
Resident Physician
NYU Langone Health Center, United States
Disclosure information not submitted.
Justin Berkowitz, DO
Safety and Quality Fellow
NYU Langone Health Center, United States
Disclosure information not submitted.
Jordan Swartz, MD
Clinical Associate Professor
NYU Langone Health Center, United States
Disclosure information not submitted.
Silas Smith, MD
Clinical Associate Professor
NYU Langone Health Center, United States
Disclosure information not submitted.
David Lee, MD
Clinical Assistant Professor
NYU Langone Health Center, United States
Disclosure information not submitted.
Cassidy Dahn, MD
Clinical Assistant Professor , Associate Chief of Service
NYU Langone Health Center, United States
Disclosure information not submitted.
Title: Unplanned ICU Transfers during COVID: Increased Mortality During Surges
Introduction:
The coronavirus 2019 (COVID-19) pandemic continues to affect hospital systems around the world, with a particularly high burden on intensive care unit (ICU) beds. Certain patients may not initially require ICU level care, but may rapidly deteriorate. We investigated unplanned ICU transfers (UIT) during COVID-19, which we defined as an upgrade to the ICU within 24 hours of a non-ICU level admission from the Emergency Department.
Methods:
This was a retrospective cohort study of a single healthcare system during two different time periods during the COVID-19 pandemic (a high-volume spring 2020 surge and a lower volume 3-month period 6 months later). We evaluated all patients admitted from the Emergency Department to a non-ICU setting with UIT within 24 hours of admission.
Results:
The total patient census was similar across time periods (5730 patient discharges versus an average 6540 for the month in surge and non-surge), however, there were a total of 2474 COVID patients over the month admitted from the ED during surge versus 846 COVID per month during non-surge. Furthermore, the level of care requirement was higher during surge with a consistently higher ICU census (17.53% versus 11.21% ICU days per total patient days).
During the high-volume surge, there were 87 UITs over the course of a month. 60 were COVID positive patients who had a mortality rate of 65.0%; 27 were COVID negative with a 33.3% mortality rate. In the subsequent non-surge period, 117 UITs occurred (39 per month). 27 were COVID positive, with a 33.3% mortality rate; 90 were COVID negative, with a 12.2% mortality rate. During surge, mortality among COVID positive patients was 2.0 times higher (p = 0.02) and 2.7 times higher among COVID negative patients (p = 0.01) when compared to the non-surge time period.
Conclusion:
While outcomes among hospitalized COVID-19 patients improved substantially during the pandemic, we found mortality risk among UITs were similarly much higher on a relative basis when comparing COVID positive and negative patients during surge versus non-surge periods. These results suggest that capacity is a critical element in the effective triage of critically ill patients.