Albert Einstein College of Medicine, Bronx, New York, USA.
Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA.
BMJ Open. 2022 Feb 15;12(2):e058171. doi: 10.1136/bmjopen-2021-058171.
COVID-19 first struck New York City in the spring of 2020, resulting in an unprecedented strain on our healthcare system and triggering multiple changes in public health policy governing hospital operations as well as therapeutic approaches to COVID-19. We examined inpatient mortality at our centre throughout the course of the pandemic.
This is a retrospective chart review of clinical characteristics, treatments and outcome data of all patients admitted with COVID-19 from 1 March 2020 to 28 February 2021. Patients were grouped into 3-month quartiles. Hospital strain was assessed as per cent of occupied beds based on a normal bed capacity of 1491.
Inpatient mortality decreased from 25.0% in spring to 10.8% over the course of the year. During this time, use of remdesivir, steroids and anticoagulants increased; use of hydroxychloroquine and other antibiotics decreased. Daily bed occupancy ranged from 62% to 118%. In a multivariate model with all year's data controlling for demographics, comorbidities and acuity of illness, percentage of bed occupancy was associated with increased 30-day in-hospital mortality of patients with COVID-19 (0.7% mortality increase for each 1% increase in bed occupancy; HR 1.007, CI 1.001 to 1.013, p=0.004) CONCLUSION: Inpatient mortality from COVID-19 was associated with bed occupancy. Early reduction in epicentre hospital bed occupancy to accommodate acutely ill and resource-intensive patients should be a critical component in the strategic planning for future pandemics.
2020 年春季，新冠病毒首次袭击纽约市，导致我们的医疗系统承受前所未有的压力，并引发了多项公共卫生政策的变化，这些政策涵盖了医院运营以及新冠病毒治疗方法。我们在整个疫情期间调查了我们中心的住院患者死亡率。
这是对 2020 年 3 月 1 日至 2021 年 2 月 28 日期间因新冠病毒住院的所有患者的临床特征、治疗和结局数据进行的回顾性图表审查。患者被分为 3 个月的四分位组。根据 1491 张标准床位的正常床位容量，评估医院的压力为占用床位的百分比。
住院患者死亡率从春季的 25.0%下降到全年的 10.8%。在此期间，瑞德西韦、类固醇和抗凝剂的使用增加；羟氯喹和其他抗生素的使用减少。每日床位占用率在 62%至 118%之间。在一个包含全年数据的多变量模型中，控制了人口统计学、合并症和疾病严重程度，床位占用率与新冠病毒患者 30 天住院死亡率增加相关（床位占用率每增加 1%，死亡率增加 0.7%；HR 1.007，CI 1.001 至 1.013，p=0.004）。
新冠病毒住院患者死亡率与床位占用率有关。为了容纳急性重病和资源密集型患者，应尽早减少疫情中心医院的床位占用率，这应成为未来大流行战略规划的关键组成部分。
