Same hospital system, vastly different COVID death rates. Here's why.
A Swedish study of three ICUs in the same hospital network found stark differences in mortality rates despite treating similar patients—pointing to how clinical management choices, staffing levels, and socioeconomic factors can swing outcomes. The findings suggest that optimizing treatment protocols and resource allocation, rather than patient population alone, may be key to reducing preventable deaths.
Originaltitel: Factors related to COVID-19 mortality among three Swedish intensive care units-A retrospective study
<p>Background Mortality due to acute hypoxemic respiratory failure (AHRF) in patients with coronavirus disease-19 (COVID-19) differs across units, regions, and countries. These variations may be attributed to several factors, including comorbidities, acute physiological derangement, disease severity, treatment, ethnicity, healthcare system strain, and socioeconomic status. This study aimed to explore the features of patient characteristics, clinical management, and staffing that may be related to mortality among three intensive care units (ICUs) within the same hospital system in South Sweden.Methods We retrospectively analyzed ICU patients with COVID-19 and AHRF in Region Jonkoping County, Sweden. The primary outcome was the 90-day mortality rate. We used univariate and multivariable logistic regression analyses to investigate the relationship of predictors with outcomes.Results Between March 15, 2020, and May 31, 2021, 331 patients with AHRF and COVID-19 were admitted to the three ICUs. There were differences in disease severity, treatments, process-related factors, and socioeconomic factors between the units. These factors were related to 90-day mortality. After multivariable adjustment, age, severity of acute respiratory distress syndrome, and the number of nurses per ICU-bed independently predicted 90-day mortality.Conclusion Age, disease severity, and nurse staffing, but not treatment or socioeconomic status, were independently associated with 90-day mortality among critically ill patients with AHRF due to COVID-19. We also identified variations in care related processes, which may be a modifiable risk factor and warrants future investigation.</p>