Data Shows Strain on ICU Capacity Leads to More Deaths During COVID-19 Pandemic

Coronavirus Disease 2019 (COVID-19) Intensive Care Unit (ICU) Load and Demand at an Example Facility. Black solid vertical line with arrows indicates the numbers at 1 time point used to calculate COVID-19 ICU load, defined as the mean number of patients with COVID-19 in the ICU during a patient’s hospital stay divided by the number of ICU beds. Black dotted vertical line indicates the numbers at 1 time point used to calculate COVID-19 demand, defined as the mean number of patients with COVID-19 in the ICU during a patient’s hospital stay divided by the maximum number of patients with COVID-19 in the ICU during the study period. The results suggest that the risk of mortality would be highest if a COVID-19 patient’s stay was during the peak of ICU demand and if ICU caseload approached or exceeded ICU bed capacity.

The COVID-19 pandemic is straining health systems across the country, especially intensive care units. New research from the U.S. Department of Veterans Affairs, Regenstrief Institute and Indiana University School of Medicine shows that people treated in the ICU for COVID-19 are twice as likely to die when the ICU capacity is strained by the number of COVID-19 patients.

“These results demonstrate that patients with COVID-19 are more likely to die if they are admitted to an ICU during times with peak COVID-19 caseload,” said Dawn Bravata, M.D., first author of the study. “We know that strain on hospital capacity has been associated with increased mortality under normal circumstances. This study provides evidence that the same is true during the current pandemic.” Dr. Bravata is a core investigator in the VA Health Services Research and Development Center for Health Information and Communication, a Regenstrief research scientist and an IU School of Medicine professor.

The research team looked at the health outcomes of 8,516 COVID-19 patients who were admitted to 88 VA hospitals across the country from March through August 2020. The team measured the strain on the hospitals’ critical care capacity by comparing the number of critically ill COVID-19 patients to the typical ICU bed count and the ICU caseload for each patient’s stay in the hospital.

After analyzing the data, they found patients who were admitted during peak times of COVID-19 ICU demand were up to two times more likely to die than those admitted under less strained periods.

“Hospital and health leaders may want to consider tracking COVID-19 ICU demand as they coordinate COVID-19 admissions to improve patient outcomes and potentially save lives,” said Dr. Bravata.

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