Objectives: To describe the relationship between reported serious operational problems (SOPs), and mortality for patients with COVID-19 admitted to intensive care units (ICUs).
Design: English national retrospective cohort study.
Setting: 89 English hospital trusts (i.e. small groups of hospitals functioning as single operational units).
Patients: All adults with COVID-19 admitted to ICU between 2nd April and 1st December, 2020 (n = 6,737).
Interventions: N/A.
Main Outcomes And Measures: 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.
Results: 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.
Conclusion And Relevance: 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.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8321157 | PMC |
| http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255377 | PLOS |
Publication Analysis
Top Keywords
Similar Publications
colorectal cancer is a common and serious condition, with surgical resection being the primary treatment for localized cases. Anastomotic dehiscence (AD) remains a significant postoperative complication, and anastomoses are typically created using either manual suturing or mechanical stapling, each with specific benefits and challenge. Material and this retrospective study analyzed outcomes in 100 rectal cancer patients who underwent surgical resection, with anastomoses performed via manual suturing (n=50) or mechanical stapling (n=50).
View Article and Find Full Text PDFRecommendations of the Brazilian Society of Surgical Oncology for the Treatment of Neoplastic Pericardial Effusion.
J Surg Oncol
December 2024
Brazilian Society of Surgical Oncology, São Paulo, Brazil.
This document presents guidelines to assist surgeons in the diagnosis and management of this condition, emphasizing a multidisciplinary approach. Recommendations described by a group of physicians members of the Brazilian Society of Oncological Surgery regarding the treatment of neoplastic pericardial effusion, developed to guide oncological surgeons, cardiothoracic surgeons and general surgeons in their clinical practice. Members of the Thoracic Neoplasms Committee carried out a literature review and discussion among expert peers to create a guideline that would help in managing this very serious clinical condition in our oncology practice: Neoplastic pericardial effusion.
View Article and Find Full Text PDFTraumatic cervical spinal cord injury in southeastern Norway: acute treatment, specialized rehabilitation referral and mortality.
Front Neurol
December 2024
Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
Background: Traumatic cervical spinal cord injury (cSCI) is a serious condition that requires a multidisciplinary treatment approach involving care at a neurotrauma center (NTC) and specialized rehabilitation. Contemporary population-based studies of cSCI are important for ensuring the quality and planning of health care approaches for these patients.
Methods: This is a population-based cohort study of patients with traumatic cSCI who were admitted to the NTC in Southeast Norway between 2015 and 2022.
Sunset Sign Due to Intraventricular Tension Pneumocephalus: A Key Clue to Evaluating Delayed Emergence After General Anesthesia.
Cureus
November 2024
Anesthesiology and Pain Medicine, Harborview Medical Center, Seattle, USA.
Prompt emergence from general anesthesia is crucial after neurosurgical procedures, such as craniotomies, to facilitate timely neurological evaluation for identification of intraoperative complications. Delayed emergence can be caused by residual anesthetics, metabolic imbalances, and intracranial pathology, for which an eye examination can provide early diagnostic clues. The sunset sign (or setting sun sign), characterized by a downward deviation of the eyes, can be an early indicator of raised intracranial pressure (ICP) or midbrain compression, as is commonly observed in states of hydrocephalus or periaqueductal or tectal plate dysfunction.
View Article and Find Full Text PDFCalciphylaxis: A Case Report and Review of the Role of Sodium Thiosulphate and Other Treatment Modalities.
Cureus
November 2024
Nephrology, Colchester Hospital, Colchester, GBR.
Calciphylaxis is a rare and serious disorder almost exclusively seen in patients on dialysis or those with advanced chronic kidney disease (CKD) not on dialysis and is associated with very high mortality. We present the case of a 50-year-old male with a background of end-stage renal disease (ESRD) compliant with dialysis, parathyroid adenoma, secondary hyperparathyroidism, and high body mass index (BMI). Whilst receiving 31 doses of intravenous sodium thiosulphate (STS) over an 11-week period, the patient underwent surgical debridement of multiple painful ulcerative lesions in his lower abdomen and left thigh and then subsequently a subtotal parathyroidectomy at 70 days from admission.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!