Impact of COVID-19 on In-Hospital Mortality Rates Across 3,000+ Hospitals

Nurses and doctors taking care of ill patients during the COVID-19 pandemic.

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In this cross-sectional investigation, 3,283 acute care hospitals across 36 states showed a rise in pressure ulcers and in-hospital mortality rates for nonsurgical care in 2020 during weeks with high COVID-19 admissions compared to those with lower admissions. Rates of pressure ulcers, heart failure mortality, and hip fracture mortality increased by at least 20% during high COVID-19 admission weeks. Occurrences of COVID-19 surges correlated with decreases in hospital quality, underscoring the need to identify and implement strategies for care quality during periods of elevated hospital utilization.

Pressure ulcer rates increased by 0.09 per 1000 admissions (95% CI, 0.01-0.17 per 1000 admissions; relative change, 24.3%), heart failure mortality increased by 0.40 per 100 admissions (95% CI, 0.18-0.63 per 100 admissions; relative change, 21.1%), hip fracture mortality increased by 0.40 per 100 admissions (95% CI, 0.04-0.77 per 100 admissions; relative change, 29.4%), and a weighted mean of mortality for the selected indicators increased by 0.30 per 100 admissions (95% CI, 0.14-0.45 per 100 admissions; relative change, 10.6%).

Main Takeaways

  1. The study reveals a link between high COVID-19 admissions and worsened hospital quality indicators, including increased rates of pressure ulcers and in-hospital mortality for nonsurgical care.
  2. Factors such as staffing shortages, inadequate training, restrictive visitor policies, and supply chain limitations were identified as contributors to the decline in care quality during peak pandemic periods, highlighting the difficulties faced by healthcare systems in maintaining standards amidst heightened demand.
  3. Strategies such as addressing staffing shortages, implementing best practices, and leveraging technology are suggested to enhance hospital resilience and mitigate the impact of heightened demand on patient outcomes.

“Our findings show that compared with 2019, pressure ulcer rates decreased 32.4% during weeks with low COVID-19 admissions in 2020, whereas we found no evidence of a change during weeks with high COVID-19 admissions in 2020. The significant difference between high and low COVID-19 admissions reflects a positive association between COVID-19 burden and pressure ulcer rates, a key measure of complications from care,” according to investigators.

The analysis encompassed 19,111,629 discharges (50.3% female) from 3283 hospitals in 36 states. Between weeks 18-48 of 2020, 35,851 hospital weeks (36.7%), exhibited low COVID-19 admission rates, while 8,094 (8.3%) showed high rates.

“Our results show decreases in age and comorbidities in weeks with high vs low COVID-19 admissions,” according to the investigators. “They suggest that, on average, patients admitted during weeks with high COVID-19 admissions were healthier prior to admission compared with weeks with low COVID-19 admissions.”

Data from the 2019 and 2020 Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project State Inpatient Databases were utilized. Information was gathered from all nonfederal, acute care hospitals in 36 states that admitted patients in 2019 and 2020.

“For heart failure, hip fracture, and our summary measure of in-hospital mortality for nonsurgical care, we did not find evidence of a change in mortality during weeks in 2020 with low COVID-19 admissions,” according to the investigators. “We found increases in mortality during weeks in 2020 with high COVID-19 admissions. Several factors may have contributed to these decreases in care quality and worse outcomes, including staff shortages, assignment of inadequately trained staff to medical floors for patients without COVID-19, restrictive visitor policies limiting family support at the bedside, inability to monitor and manage changes in patient disposition, inadequate or lack of protective equipment to prevent the spread of infections due to supply chain limitations, and impaired quality improvement processes.”

The study acknowledges limitations. Despite incorporating comprehensive case-mix controls into their models, the researchers note the possibility of spurious correlations between unmeasured aspects of patient severity and variations in COVID-19 admissions. Additionally, they mention being unable to adjust for subnational trends, including shortages in supplies and staff.

These findings emphasize the importance of preserving healthcare standards during intense hospital activity, such as the COVID-19 pandemic. Measures like addressing staffing gaps, ensuring safety protocols, adopting effective organizational strategies, and utilizing technology can bolster hospital resilience in times of high demand.

Meille G, Owens P, Decker S, et. al. COVID-19 Admission Rates and Changes in Care Quality in US Hospitals. JAMA Netw Open. Published May 24, 2024. Accessed May 28, 2024. doi: 10.1001/jamanetworkopen.2024.13127

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