Impact of transferring COVID-19 patients on hospital mortality

Scientific Research Project Number: MA 2021 09
Place: Amsterdam UMC, Locatie AMC, afdeling Klinische Informatiekunde -KIK

Introduction

During the COVID-19 epidemic in the Netherlands, patients admitted to an ICU were often transferred to make room for high emergency patients and to prevent overload. Transferring a patient is a moment of discontinuity in care and is not free of risk [1-3]. However, a previous study conducted on Dutch COVID-19 data found that there was no association between transferring COVID-19 patients and hospital mortality [4]. One of the limitations of this study was that no distinction was made between patients transferred due to limited ICU capacity or transferred due to the complexity of the patient’s disease and continuation of care in a more specialized ICU. Moreover, the distance between hospitals was not taken into account in the analyses. In general, the larger the distance between hospitals, the more time is needed to transfer the patient. In this research project, the aim is to analyze the association between transferring COVID-19 patients and hospital mortality in more detail. In addition to patient characteristics, timing during epidemic, size and occupancy rate of the ICU, and transfer information, such as travel distance will also be considered.


Description of the SRP Project/Problem

The project will consist of a literature search on factors that determine the transfer of ICU patients and whether these should (and can) be included as confounders in order to further analyze the association between transfer and mortality.

Furthermore, the project will consist of analyzing COVID-19 data from Stichting NICE, a quality registry containing demographic, physiological, and clinical data of all adult ICU patients in the Netherlands [5,6]. Mortality of patients who were transferred will be compared to the mortality of those who were not transferred. A crude Odds Ratio (OR) will be estimated in a logistic model with hospital death as outcome. Next, this OR will be adjusted for important patient characteristics, size and occupancy rate of the ICU, timing during epidemic, and information of the transfer such as geographic distance and type of hospital (academic vs. non-academic).


Research questions

What is the effect of transferring COVID-19 patients on the outcome of these patients, taking into account clinical characteristics, timing during epidemic, travel distance, size and occupancy rate of the ICU?


Expected results

An English written manuscript of max 3500 words


Time period 7 months

start 1 November 2021- 1 July 2021


Contact

Safira Wortel, Amsterdam UMC, location AMC, department of Medical Informatics, s.a.wortel@amsterdamumc.nl

Ferishta Bakhshi-Raiez, Amsterdam UMC, location AMC, department of Medical Informatics, f.raiez@amsterdamumc.nl


References:

1. Beckmann U, Gillies DM, Berenholtz SM, Wu AW, Pronovost P. Incidents relating to the intra-hospital transfer of critically ill patients: An analysis of the reports submitted to the Australian Incident Monitoring Study in Intensive Care. Vol. 30, Intensive Care Medicine. 2004. p. 1579–85.

2. Parmentier-Decrucq E, Poissy J, Favory R, Nseir S, Onimus T, Guerry MJ, et al. Adverse events during intrahospital transport of critically ill patients: Incidence and risk factors. Ann Intensive Care. 2013;3(1):1–10. Available from:

3. van Lieshout EJ, Binnekade J, Reussien E, Dongelmans D, Juffermans NP, de Haan RJ, et al. Nurses versus physician-led interhospital critical care transport: a randomized non-inferiority trial. Intensive Care Med. 2016 Jul 1;42(7):1146–54.

4. Wortel et al. Comparison of patient characteristics and mortality between transferred and non-transferred COVID-19 patients in Dutch Intensive Care Units; A national cohort study [SUBMITTED]

5. Dutch National Intensive Care Evaluation (NICE) https://stichting-nice.nl/

6. Van De Klundert N, Holman R, Dongelmans DA, De Keizer NF. Data Resource Profile: The Dutch National Intensive Care Evaluation (NICE) Registry of Admissions to Adult Intensive Care Units. Int J Epidemiol. 2015;44(6):1850.


Contact

Safira Wortel, Amsterdam UMC, location AMC, department of Medical Informatics, s.a.wortel@amsterdamumc.nl
Ferishta Raiez, Amsterdam UMC, location AMC, department of Medical Informatics, f.raiez@amsterdamumc.nl