A Minnesota health system that established two COVID-19 patient-only hospitals early in the pandemic had lower rates of coronavirus-related death than hospitals with mixed patient cohorts, according to a study published yesterday in JAMA Network Open.
University of Minnesota at Minneapolis researchers studied the outcomes of 5,504 adult COVID-19 patients treated at M Health Fairview from Mar 1, 2020, to Jun 30, 2021, from 11 hospitals, including 2 reserved for the treatment of COVID-19 patients. Median patient age in the entire cohort was 62.5 years, and 51.9% were women.
Of the 5,504 patients, 2,077 (37.7%) were treated at one of the two dedicated hospitals in St. Paul, and 3,427 (62.3%) were cared for at the other hospitals.
Deaths 22% to 25% lower, despite sicker patients
The death rate at the COVID-dedicated hospitals was 11.6%, compared with 8.0% at other hospitals. The risk-adjusted odds of in-hospital death, however, were significantly lower in the dedicated hospitals in both the 2,077 unmatched controls (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.59 to 0.95) and the 1,317 propensity score–matched patients (OR, 0.78; 95% CI, 0.58 to 0.99)—or a 22% to 25% lower risk.
Patients in nondedicated hospitals, relative to those in dedicated hospitals, were significantly different in nearly all demographic, clinical, and lab factors. More severely ill patients were admitted to the dedicated hospitals, which had a 41.0% rate of intensive care unit (ICU) admission, compared with 18.2% in the other hospitals.
In the propensity score-matched group, accounting for the difference in illness severity between the two groups, the rate of complications was significantly lower (OR, 0.81; 95% CI, 0.66 to 0.99) in the dedicated hospitals, while the use of COVID-specific treatments was significantly higher. Such therapies included prevention of deep vein thrombosis (83.9% vs 56.9%), high-dose corticosteroids (56.1% vs 22.2%), the antiviral medication remdesivir (61.5% vs 44.5%), and the monoclonal antibody tocilizumab (7.9% vs 2.0).
All five sensitivity analyses showed improved survival in patients admitted to a COVID-19 hospital.
Health system-wide survival to hospital release was 90.8%. ICU admissions accounted for 26.9% of all hospitalized patients surviving to release, for a survival rate of 75.1%. Among 539 hospitalized patients, 9.8% required mechanical ventilation. Median hospital length of stay for all patients was 5.0 days, and median stay among ICU patients was 5.4 days.
"In this cohort study, COVID-19–dedicated hospitals had multiple benefits, including providing high-volume repetitive treatment and isolating patients with the infection," the researchers concluded. "This experience suggests improved in-hospital mortality for patients treated at dedicated hospitals owing to improved processes of care and supports the use of establishing cohorts for future pandemics."
Hospitals converted in 2020
When COVID-19 cases surged in March 2020, the health system converted a hospital into a COVID-19 hospital with 35 ICU beds and 55 general-care beds. Amid increasing demand in November 2020, COVID-19 care transitioned to another hospital with 41 ICU beds and 68 general-floor beds through June 2021, when it was no longer needed.
The health system installed telemetry capabilities, creating negative airflow in patient rooms with high-efficiency particulate air (HEPA)-filter fans, and updating interventional radiologic and procedural suites. Medical and surgical intensivists, hospitalists, and ICU and general floor nurses staffed the hospital.
Both hospitals used protocols to ensure that healthcare workers had easy access to personal protective equipment and were able to closely monitor evolving evidence-based COVID-19 therapy recommendations. They used dedicated order sets and documentation templates to ensure rapid delivery of COVID-19 treatments.
Major clinical trials were held at the hospitals, generating a Sep 3, 2021, study on the use of interhospital transfer to the dedicated hospitals, the link between use of these hospitals and quality care measures, and healthcare worker satisfaction. All COVID-19 patients in the entire health system were also added to a large prospective database.
In a University of Minnesota Medical School news release, coauthor Andrew Olson, MD, called the ability to care for patients at dedicated COVID-19 hospitals "a shining light in a dark time for many of us. We watched our colleagues develop expertise, conduct research and care for one another while staying healthy in a challenging time."
Note: The Center for Infectious Disease Research and Policy, which publishes CIDRAP News, is housed at the University of Minnesota but was not involved in the study.
