Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb 15;12(2):e058171.
doi: 10.1136/bmjopen-2021-058171.

Hospital bed occupancy rate is an independent risk factor for COVID-19 inpatient mortality: a pandemic epicentre cohort study

Francesco Castagna  1   2 , Xiaonan Xue  3 , Omar Saeed  1   2 , Rachna Kataria  4 , Yoram A Puius  1   5 , Snehal R Patel  1   2 , Mario J Garcia  1   2 , Andrew D Racine  1   6 , Daniel B Sims  1   2 , Ulrich P Jorde  7   2
Affiliations

Hospital bed occupancy rate is an independent risk factor for COVID-19 inpatient mortality: a pandemic epicentre cohort study

Francesco Castagna et al. BMJ Open. .

Abstract

Introduction: COVID-19 first struck New York City in the spring of 2020, resulting in an unprecedented strain on our healthcare system and triggering multiple changes in public health policy governing hospital operations as well as therapeutic approaches to COVID-19. We examined inpatient mortality at our centre throughout the course of the pandemic.

Methods: This is a retrospective chart review of clinical characteristics, treatments and outcome data of all patients admitted with COVID-19 from 1 March 2020 to 28 February 2021. Patients were grouped into 3-month quartiles. Hospital strain was assessed as per cent of occupied beds based on a normal bed capacity of 1491.

Results: Inpatient mortality decreased from 25.0% in spring to 10.8% over the course of the year. During this time, use of remdesivir, steroids and anticoagulants increased; use of hydroxychloroquine and other antibiotics decreased. Daily bed occupancy ranged from 62% to 118%. In a multivariate model with all year's data controlling for demographics, comorbidities and acuity of illness, percentage of bed occupancy was associated with increased 30-day in-hospital mortality of patients with COVID-19 (0.7% mortality increase for each 1% increase in bed occupancy; HR 1.007, CI 1.001 to 1.013, p=0.004) CONCLUSION: Inpatient mortality from COVID-19 was associated with bed occupancy. Early reduction in epicentre hospital bed occupancy to accommodate acutely ill and resource-intensive patients should be a critical component in the strategic planning for future pandemics.

Keywords: COVID-19; epidemiology; public health.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Simultaneously admitted patients. This graph includes hospitalised and admitted patients in the emergency department waiting for a bed. A precipitous decline of non-COVID-19 admissions began on 16 March 2020 (vertical grey line) coinciding with gubernatorial healthcare-associated directives in New York State. The dotted red line indicates the nominal bed capacity of our institution (1491 beds).
Figure 2
Figure 2
Cumulative monthly admissions (black line, left axis) and mortality (dotted red line, right axis) over the year.
Figure 3
Figure 3
Change in therapies: per cent of patients receiving specific therapies over the year.
Figure 4
Figure 4
Cumulative incidence: 30-day in-hospital mortality (A) by season and (B) spring vs winter after propensity score matching. PS, propensity score.
See this image and copyright information in PMC

References

    1. World Health Organization . WHO Director-General’s opening remarks at the media briefing on COVID-19-11 March 2020. Geneva, Switzerland, 2020.
    1. Bhatraju PK, Ghassemieh BJ, Nichols M, et al. Covid-19 in critically ill patients in the Seattle region — case series. N Engl J Med 2020;382:2012–22. 10.1056/NEJMoa2004500 - DOI - PMC - PubMed
    1. John Hopkins University . COVID-19 Dashboard by the center for systems science and engineering (CSSE) at Johns Hopkins University (JHU), 2020. Available: https://coronavirus.jhu.edu/map.html [Accessed 20 Jan 2021].
    1. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the global burden of disease study 2010. Lancet 2012;380:2095–128. 10.1016/S0140-6736(12)61728-0 - DOI - PMC - PubMed
    1. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054–62. 10.1016/S0140-6736(20)30566-3 - DOI - PMC - PubMed

Publication types