A national retrospective study of the association between serious operational problems and COVID-19 specific intensive care mortality risk.

To describe the relationship between reported serious operational problems (SOPs), and mortality for patients with COVID-19 admitted to intensive care units (ICUs). English national retrospective cohort study. 89 English hospital trusts (i.e. small groups of hospitals functioning as single operational units). All adults with COVID-19 admitted to ICU between 2nd April and 1st December, 2020 (n = 6,737). N/A. Hospital trusts routinely submit declarations of whether they have experienced 'serious operational problems' in the last 24 hours (e.g. due to staffing issues, adverse weather conditions, etc.). Bayesian hierarchical models were used to estimate the association between in-hospital mortality (binary outcome) and: 1) an indicator for whether a SOP occurred on the date of a patient's admission, and; 2) the proportion of the days in a patient's stay that had a SOP occur within their trust. These models were adjusted for individual demographic characteristics (age, sex, ethnicity), and recorded comorbidities. Serious operational problems (SOPs) were common; reported in 47 trusts (52.8%) and were present for 2,701 (of 21,716; 12.4%) trust days. Overall mortality was 37.7% (2,539 deaths). Admission during a period of SOPs was associated with a substantially increased mortality; adjusted odds ratio (OR) 1.34 (95% posterior credible interval (PCI): 1.07 to 1.68). Mortality was also associated with the proportion of a patient's admission duration that had concurrent SOPs; OR 1.47 (95% PCI: 1.10 to 1.96) for mortality where SOPs were present for 100% compared to 0% of the stay. Serious operational problems at the trust-level are associated with a significant increase in mortality in patients with COVID-19 admitted to critical care. The link isn't necessarily causal, but this observation justifies further research to determine if a binary indicator might be a valid prognostic marker for deteriorating quality of care.

Déclaration de conflit d'intérêts

SJV declares previous funding from IQVIA, unrelated to this work. APM declares previous research funding from Eli Lilly and Company, Pfizer, and AstraZeneca; all unrelated to this work. BAM is an employee of the Wellcome Trust, and holds a Wellcome funded honorary post at University College London for the purposes of carrying out independent research; the views expressed in this manuscript do not necessarily reflect the views or position of the Wellcome Trust. There are no patents, products in development or marketed products to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.