Impact of an Early Warning System Protocol, for Patients Admitted to the Medical Floors with SARS-COV2 Pneumonia, on ICU Admission

Seife Yohannes; Nitin Seam; Junfeng Sun; Joel McAlduff; Janet L Thorne; Susanne B Lara; Michael Keller

doi:10.1177/11795484231156755

Impact of an Early Warning System Protocol, for Patients Admitted to the Medical Floors with SARS-COV2 Pneumonia, on ICU Admission

Clin Med Insights Circ Respir Pulm Med. 2023 Mar 21:17:11795484231156755. doi: 10.1177/11795484231156755. eCollection 2023.

Authors

Seife Yohannes¹, Nitin Seam², Junfeng Sun², Joel McAlduff³, Janet L Thorne⁴, Susanne B Lara¹, Michael Keller²

Affiliations

¹ Department of Critical Care, MedStar Washington Hospital Center, Washington DC, USA.
² Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
³ Medstar Health, Columbia, Maryland, USA.
⁴ MedStar Washington Hospital Center, Washington DC, USA.

Abstract

Background: COVID-19 placed a significant burden on the global healthcare system. Strain in critical care capacity has been associated with increased COVID-19-related ICU mortality. This study evaluates the impact of an early warning system and response team implemented on medical floors to safely triage and care for critically ill patients on the floor and preserve ICU capacity.

Methods: We conducted a multicenter, retrospective cohort study, comparing outcomes between intervention and control hospitals within a US eight-hospital urban network. Patients hospitalized with COVID-19 pneumonia between April 13^th, 2020 and June 19^th, 2020 were included in the study, which was a time of a regional surge of COVID-19 admissions. An automated, electronic early warning protocol to identify patients with moderate-severe hypoxemia on the medical floors and implement early interventions was implemented at one of the eight hospitals ("the intervention hospital").

Results: Among 1024 patients, 403 (39%) were admitted to the intervention hospital and 621 (61%) were admitted to one of the control hospitals. Adjusted for potential confounders, patients at the intervention hospital were less likely to be admitted to the ICU (HR = 0.73, 95% CI 0.53, 1.000, P = .0499) compared to the control hospitals. Patients admitted from the floors to the ICU at the intervention hospital had shorter ICU stay (HR for ICU discharge: 1.74; 95% CI 1.21, 2.51, P = .003). There was no significant difference between intervention and control hospitals in need for mechanical ventilation (OR = 0.93; 95% CI 0.38, 2.31; P = .88) or hospital mortality (OR = 0.79; 95% CI 0.52, 1.18; P = .25).

Conclusion: A protocol to conserve ICU beds by implementing an early warning system with a dedicated response team to manage respiratory distress on the floors reduced ICU admission and was not associated with worse outcomes compared to hospitals that managed similar levels of respiratory distress in the ICU.

Keywords: ARDS; COVID-19; Early warning system; ICU capacity; SARS-COV2; pandemic; pneumonia.