Survival in Newly Created Hospital Units in Response to COVID 19 Pandemic Crisis

Importance: New York City (NYC) was the first major US city struck by the novel Coronavirus (COVID-19) with significant infection rates, mechanical intubations, and subsequent mortality. New hospital units were created to accommodate the surge of pandemic patients.

Objective: The objective of this study is to examine the outcomes of COVID-19 patients admitted to a community teaching NYC hospital with newly created units and compare them to outcomes of patients admitted to established hospital units to determine if there is a mortality difference.

Design: We retrospectively collected data on patients hospitalized with laboratory-confirmed COVID-19 infection between March 8, 2020 and April 7, 2020. Included were patient demographics, comorbidities, risk factors, clinical factors, laboratory data, imaging studies, hospital course, and outcomes obtained from our electronic medical records. Data were analyzed between two cohorts: new hospital units (NHU) and established hospital units (EHU) to determine if a mortality difference existed.

Setting: The study is based on a 454-bed community teaching hospital in NYC at a location that serves an ethnically diverse population using population-based data.

Participants: All patients included in our study were 17 years or greater in age. The study endpoint was defined as either patient discharge or death, and pregnant women and patients who died in the Emergency Department before admission were excluded from the analysis.

Results: Of the 1288 screened patients, 351 confirmed COVID-19 hospitalized patients were included in our analysis. Specifically, the racial demographics for African Americans were similar between both units (p=0.139). Factors such as elevated BUN, ferritin, lactate dehydrogenase, and troponin were found to be similar in both cohorts. Overall survival was higher for patients in EHU compared to NHU (p=.012). The mortality rate was most striking in the NHU ICU where the mortality, especially in patients on mechanical ventilation (MV), was higher than in EHU ICU units (p = <.004).

Conclusion: Our analysis revealed that patients admitted to newly created hospital units had a significantly lower overall survival rate compared to those admitted to established units, particularly in the NHU ICUs, especially for MV patients. These findings highlight the need for better planning, including the development of protocols that encompass trained providers' assignment, competency, proper orientation to the new unit, team cohesion, familiarity with the equipment, and critically ill patients' allocation. Such measures can help mitigate the survivorship disadvantage observed during surges in hospitalizations, particularly when NHU, especially new ICUs, need to be created.