February 1, 2021

Data shows strain on ICU capacity leads to more deaths during COVID-19 pandemic

COVID-19 ICU patients twice as likely to die if treated during peak COVID-19 ICU demand

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.

Association of Intensive Care Unit Patient Load and Demand with Patient Mortality Rates In US Department of Veterans Affairs Hospitals During the COVID-19 Pandemic” was published online in JAMA Network Open. This work was supported by the United States Department of Veterans Affairs Health Services Research & Development Service Precision Monitoring to Transform Care Quality Enhancement Research Initiative (QUE 15-280).

In addition to Dr. Bravata, authors on the paper are Anthony Perkins, M.S. of VA HSR&D PRISM QUERI and IU School of Medicine; Laura Myers, PhD of VA HSR&D PRISM QUERI and Center for Health Information and Communication (CHIC), IU School of Medicine and Regenstrief Institute; Greg Arling, PhD of VA HSR&D PRISM QUERI and Purdue University School of Nursing; Ying Zhang, PhD, M.S. of VA HSR&D PRISM QUERI and the College of Public Health at the University of Nebraska Medical Center; Alan Zillich, PharmD of Purdue University College of Pharmacy; Lindsey Reese, M.D. of the Richard L. Roudebush VA Medical Center; Andrew Dysangco, M.D. of the Roudebush VA Medical Center and IU School of Medicine; Rajiv Agarwal, M.B., B.S., of the Roudebush VA Medical Center and IU School of Medicine; Jennifer Myers, MSW of VA HSR&D PRISM QUERI and CHIC; Charles Austin, MDiv of VA HSR&D PRISM QUERI and CHIC; Ali Sexon, MBA of VA HSR&D PRIS-M QUERI and CHIC; Samuel Leonard, MSW of the Northern California Institute for Research and Education; Sharmistha Dev, M.D., MPH of VA HSR&D CHIC, Roudebush VA Medical Center and Regenstrief Institute; and Salomeh Keyhani, M.D. of VA HSR&D PRISM QUERI, San Francisco Veterans Affairs Medical Center and University of California, San Francisco.

About the VA Health Services Research and Development Center for Health Information and Communication

The Health Services Research and Development (HSR&D) Center for Health Information and Communication (CHIC) group is a diverse cadre of researchers joining together to transform the healthcare system, both within and outside the VA so every patient receives consistent, high-quality care.

About Regenstrief Institute

Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission.

About IU School of Medicine

IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.

About Dawn M. Bravata, M.D.

In addition to her role as a research scientist at Regenstrief Institute, Dawn M. Bravata, M.D., is a professor of medicine at IU School of Medicine. She also serves as a core investigator for the U.S. Department of Veteran Affairs Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush VA Medical Center and a co-principal investigator for the VA HSR&D PRISM QUERI.

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