Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut School of Medicine, Farmington.
Agency for Healthcare Research and Quality, Department of Health and Human Services, Washington, DC.
JAMA Netw Open. 2024 Nov 4;7(11):e2442936. doi: 10.1001/jamanetworkopen.2024.42936.
The COVID-19 pandemic introduced stresses on hospitals due to the surge in demand for care and to staffing shortages. The implications of these stresses for patient safety are not well understood.
To assess whether hospital COVID-19 burden was associated with the rate of in-hospital adverse effects (AEs).
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the Agency for Healthcare Research and Quality's Quality and Safety Review System, a surveillance system that tracks the frequency of AEs among selected hospital admissions across the US. The study sample included randomly selected Medicare patient admissions to acute care hospitals in the US between September 1, 2020, and June 30, 2022.
The main outcome was the association between frequency of AEs and hospital-specific weekly COVID-19 burden. Observed and risk-adjusted rates of AEs per 1000 admissions were stratified by the weekly hospital-specific COVID-19 burden (daily mean number of COVID-19 inpatients per 100 hospital beds each week), presented as less than the 25th percentile (lowest burden), 25th to 75th percentile (intermediate burden), and greater than the 75th percentile (highest burden). Risk adjustment variables included patient and hospital characteristics.
The study included 40 737 Medicare hospital admissions (4114 patients [10.1%] with COVID-19 and 36 623 [89.9%] without); mean (SD) patient age was 73.8 (12.1) years, 53.8% were female, and the median number of Elixhauser comorbidities was 4 (IQR, 2-5). There were 59.1 (95% CI, 54.5-64.0) AEs per 1000 admissions during weeks with the lowest, 77.0 (95% CI, 73.3-80.9) AEs per 1000 admissions during weeks with intermediate, and 97.4 (95% CI, 91.6-103.7) AEs per 1000 admissions during weeks with the highest COVID-19 burden. Among patients without COVID-19, there were 55.7 (95% CI, 51.1-60.8) AEs per 1000 admissions during weeks with the lowest, 74.0 (95% CI, 70.2-78.1) AEs per 1000 admissions during weeks with intermediate, and 79.3 (95% CI, 73.7-85.3) AEs per 1000 admissions during weeks with the highest COVID-19 burden. A similar pattern was seen among patients with COVID-19. After risk adjustment, the relative risk (RR) for AEs among patients admitted during weeks with high compared with low COVID-19 burden for all patients was 1.23 (95% CI, 1.09-1.39; P < .001), with similar results seen in the cohorts with (RR, 1.33; 95% CI, 1.03-1.71; P = .03) and without (RR, 1.23; 95% CI, 1.08-1.39; P = .002) COVID-19 individually.
In this cohort study of hospital admissions among Medicare patients during the COVID-19 pandemic, greater hospital COVID-19 burden was associated with an increased risk of in-hospital AEs among both patients with and without COVID-19. These results illustrate the need for greater hospital resilience and surge capacity to prevent declines in patient safety during surges in demand.
由于对护理的需求激增和人手短缺，新冠疫情给医院带来了压力。这些压力对患者安全的影响尚不清楚。
评估医院新冠负担与院内不良事件（AE）发生率之间是否存在关联。
设计、设置和参与者：这项队列研究使用了美国医疗保健研究与质量局质量与安全审查系统的数据，该系统是一个监测系统，跟踪美国选定医院住院患者 AE 的频率。研究样本包括 2020 年 9 月 1 日至 2022 年 6 月 30 日期间美国接受 Medicare 治疗的急性护理医院的随机选择患者入院。
主要结果是 AE 频率与医院特定每周新冠负担之间的关联。每 1000 例入院的 AE 发生率和风险调整率按每周医院特定新冠负担（每周每 100 张病床的新冠住院患者每日平均数）分层，表现为低于 25 百分位数（最低负担）、25 至 75 百分位数（中等负担）和高于 75 百分位数（最高负担）。风险调整变量包括患者和医院特征。
这项研究纳入了 40737 例 Medicare 医院入院（4114 例患者[10.1%]患有新冠，36623 例[89.9%]没有）；患者平均（SD）年龄为 73.8（12.1）岁，53.8%为女性，Elixhauser 合并症中位数为 4（IQR，2-5）。在新冠负担最低的几周内，每 1000 例入院中有 59.1（95%CI，54.5-64.0）例 AE；在新冠负担中等的几周内，每 1000 例入院中有 77.0（95%CI，73.3-80.9）例 AE；在新冠负担最高的几周内，每 1000 例入院中有 97.4（95%CI，91.6-103.7）例 AE。在没有新冠的患者中，在新冠负担最低的几周内，每 1000 例入院中有 55.7（95%CI，51.1-60.8）例 AE；在新冠负担中等的几周内，每 1000 例入院中有 74.0（95%CI，70.2-78.1）例 AE；在新冠负担最高的几周内，每 1000 例入院中有 79.3（95%CI，73.7-85.3）例 AE。在患有新冠的患者中也观察到类似的模式。在风险调整后，所有患者中，与新冠负担较低的周相比，新冠负担较高的周内患者发生 AE 的相对风险（RR）为 1.23（95%CI，1.09-1.39；P < .001），在患有和不患有新冠的队列中均有类似结果（RR，1.33；95%CI，1.03-1.71；P = .03）和（RR，1.23；95%CI，1.08-1.39；P = .002）。
在这项针对新冠大流行期间 Medicare 患者住院的队列研究中，医院新冠负担增加与患有和不患有新冠的患者院内 AE 风险增加相关。这些结果表明，在需求激增期间，需要提高医院的弹性和应急能力，以防止患者安全状况下降。
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