Getting It Right First Time programme, NHS England, London, UK.
Getting It Right First Time programme, NHS England, London, UK
Emerg Med J. 2023 Aug;40(8):542-548. doi: 10.1136/emermed-2023-213329. Epub 2023 May 26.
In England, reported COVID-19 mortality rates increased during winter 2020/21 relative to earlier summer and autumn months. This study aimed to examine the association between COVID-19-related hospital bed-strain during this time and patient outcomes.
This was a retrospective observational study using Hospital Episode Statistics data for England. All unique patients aged ≥18 years in England with a diagnosis of COVID-19 who had a completed (discharged alive or died in hospital) hospital stay with an admission date between 1 July 2020 and 28 February 2021 were included. Bed-strain was calculated as the number of beds occupied by patients with COVID-19 divided by the maximum COVID-19 bed occupancy during the study period. Bed-strain was categorised into quartiles for modelling. In-hospital mortality was the primary outcome of interest and length of stay a secondary outcome.
There were 253 768 unique hospitalised patients with a diagnosis of COVID-19 during a hospital stay. Patient admissions peaked in January 2021 (n=89 047), although the crude mortality rate peaked slightly earlier in December 2020 (26.4%). After adjustment for covariates, the mortality rate in the lowest and highest quartile of bed-strain was 23.6% and 25.3%, respectively (OR 1.13, 95% CI 1.09 to 1.17). For the lowest and the highest quartile of bed-strain, adjusted mean length of stay was 13.2 days and 11.6 days, respectively in survivors and was 16.5 days and 12.6 days, respectively in patients who died in hospital.
High levels of bed-strain were associated with higher in-hospital mortality rates, although the effect was relatively modest and may not fully explain increased mortality rates during winter 2020/21 compared with earlier months. Shorter hospital stay during periods of greater strain may partly reflect changes in patient management over time.
在英格兰，与 2020 年夏秋季相比，2020/21 年冬季报告的 COVID-19 死亡率有所上升。本研究旨在探讨这段时间 COVID-19 相关病床压力与患者结局之间的关系。
这是一项使用英格兰医院入院统计数据的回顾性观察研究。纳入所有 2020 年 7 月 1 日至 2021 年 2 月 28 日期间在英格兰住院且诊断为 COVID-19 的年龄≥18 岁、完成住院（存活出院或死于院内）的唯一患者。以 COVID-19 患者占用的床位数除以研究期间 COVID-19 最大床位占用数来计算床位压力。将床位压力分为四分位进行建模。住院死亡率是主要的观察终点，住院时间是次要的观察终点。
共有 253768 例诊断为 COVID-19 的患者在住院期间接受了治疗。患者入院人数在 2021 年 1 月达到高峰（n=89047），尽管死亡率在 2020 年 12 月略早达到高峰（26.4%）。调整协变量后，床位压力最低和最高四分位数的死亡率分别为 23.6%和 25.3%（OR 1.13，95%CI 1.09 至 1.17）。对于床位压力最低和最高四分位数的存活患者，调整后的平均住院时间分别为 13.2 天和 11.6 天，而住院死亡患者的平均住院时间分别为 16.5 天和 12.6 天。
高床位压力与住院死亡率升高相关，尽管影响相对较小，且可能无法完全解释 2020/21 年冬季与前几个月相比死亡率升高的原因。在压力较大的时期，住院时间缩短可能部分反映了患者管理的变化。
