Yohannes Seife, Seam Nitin, Sun Junfeng, McAlduff Joel, Thorne Janet L, Lara Susanne B, Keller Michael
Department of Critical Care, MedStar Washington Hospital Center, Washington DC, USA.
Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
Clin Med Insights Circ Respir Pulm Med. 2023 Mar 21;17:11795484231156755. doi: 10.1177/11795484231156755. eCollection 2023.
COVID-19 placed a significant burden on the global healthcare system. Strain in critical care capacity has been associated with increased COVID-19-related ICU mortality. This study evaluates the impact of an early warning system and response team implemented on medical floors to safely triage and care for critically ill patients on the floor and preserve ICU capacity.
We conducted a multicenter, retrospective cohort study, comparing outcomes between intervention and control hospitals within a US eight-hospital urban network. Patients hospitalized with COVID-19 pneumonia between April 13, 2020 and June 19, 2020 were included in the study, which was a time of a regional surge of COVID-19 admissions. An automated, electronic early warning protocol to identify patients with moderate-severe hypoxemia on the medical floors and implement early interventions was implemented at one of the eight hospitals ("the intervention hospital").
Among 1024 patients, 403 (39%) were admitted to the intervention hospital and 621 (61%) were admitted to one of the control hospitals. Adjusted for potential confounders, patients at the intervention hospital were less likely to be admitted to the ICU (HR = 0.73, 95% CI 0.53, 1.000, = .0499) compared to the control hospitals. Patients admitted from the floors to the ICU at the intervention hospital had shorter ICU stay (HR for ICU discharge: 1.74; 95% CI 1.21, 2.51, = .003). There was no significant difference between intervention and control hospitals in need for mechanical ventilation (OR = 0.93; 95% CI 0.38, 2.31; = .88) or hospital mortality (OR = 0.79; 95% CI 0.52, 1.18; = .25).
A protocol to conserve ICU beds by implementing an early warning system with a dedicated response team to manage respiratory distress on the floors reduced ICU admission and was not associated with worse outcomes compared to hospitals that managed similar levels of respiratory distress in the ICU.
新型冠状病毒肺炎（COVID-19）给全球医疗系统带来了沉重负担。重症监护能力的紧张与COVID-19相关的重症监护病房（ICU）死亡率上升有关。本研究评估了在医疗楼层实施的早期预警系统和响应团队对安全分诊和护理楼层重症患者以及保留ICU容量的影响。
我们进行了一项多中心回顾性队列研究，比较了美国一个由八家医院组成的城市网络中干预医院和对照医院的结局。研究纳入了2020年4月13日至2020年6月19日期间因COVID-19肺炎住院的患者，这是COVID-19入院人数区域激增的时期。八家医院中的一家（“干预医院”）实施了一种自动化电子早期预警方案，以识别医疗楼层中患有中度至重度低氧血症的患者并实施早期干预。
在1024例患者中，403例（39%）入住干预医院，621例（61%）入住对照医院之一。在对潜在混杂因素进行调整后，与对照医院相比，干预医院的患者入住ICU的可能性较小（风险比[HR]=0.73，95%置信区间[CI]0.53，1.000，P=0.0499）。干预医院从楼层转入ICU的患者在ICU的住院时间较短（ICU出院的HR：1.74；95%CI 1.21，2.51，P=0.003）。干预医院和对照医院在机械通气需求（比值比[OR]=0.93；95%CI 0.38，2.31；P=0.88）或医院死亡率（OR=0.79；95%CI 0.52，1.18；P=0.25）方面没有显著差异。
通过实施早期预警系统和专门的响应团队来管理楼层呼吸窘迫以保留ICU床位的方案减少了ICU入院，并且与在ICU管理类似程度呼吸窘迫的医院相比，结局并无更差。
