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  • Risk of acute deterioration and care complexity individual factors associated with health outcomes in hospitalised patients with COVID-19: a multicentre cohort study

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Nursing
Original research
Risk of acute deterioration and care complexity individual factors associated with health outcomes in hospitalised patients with COVID-19: a multicentre cohort study
  1. Jordi Adamuz1,2,
  2. Maribel González-Samartino1,2,
  3. Emilio Jiménez-Martínez3,
  4. Marta Tapia-Pérez1,
  5. María-Magdalena López-Jiménez1,2,
  6. Hugo Rodríguez-Fernández1,
  7. Trinidad Castro-Navarro4,
  8. Esperanza Zuriguel-Pérez5,
  9. Jordi Carratala3,6,
  10. Maria-Eulàlia Juvé-Udina7
  1. 1Nursing Knowledge Management and Information Systems Department, Bellvitge University Hospital (IDIBELL), L'Hospitalet de Llobregat, Catalunya, Spain
  2. 2School of Nursing, Medicine and Health Science Faculty, University of Barcelona, Barcelona, Spain
  3. 3Department of Infectious Diseases, Bellvitge University Hospital (IDIBELL), L'Hospitalet de Llobregat, Catalunya, Spain
  4. 4Nursing Knowledge Management and Information Systems Department, University Hospital Germans Trias i Pujol, Badalona, Catalunya, Spain
  5. 5Nursing Research Deparment, Vall d'Hebron University Hospital (VHIR), Barcelona, Catalunya, Spain
  6. 6Faculty of Medicine, Deparment of Clinical Sciences, University of Barcelona, Barcelona, Spain
  7. 7Nursing Deparment, Catalan Institute of Health (IDIBELL), Barcelona, Catalunya, Spain
  1. Correspondence to Dr Maribel González-Samartino; mgsamartino67{at}gmail.com

Abstract

Background Evidence about the impact of systematic nursing surveillance on risk of acute deterioration of patients with COVID-19 and the effects of care complexity factors on inpatient outcomes is scarce. The aim of this study was to determine the association between acute deterioration risk, care complexity factors and unfavourable outcomes in hospitalised patients with COVID-19.

Methods A multicentre cohort study was conducted from 1 to 31 March 2020 at seven hospitals in Catalonia. All adult patients with COVID-19 admitted to hospitals and with a complete minimum data set were recruited retrospectively. Patients were classified based on the presence or absence of a composite unfavourable outcome (in-hospital mortality and adverse events). The main measures included risk of acute deterioration (as measured using the VIDA early warning system) and care complexity factors. All data were obtained blinded from electronic health records. Multivariate logistic analysis was performed to identify the VIDA score and complexity factors associated with unfavourable outcomes.

Results Out of a total of 1176 patients with COVID-19, 506 (43%) experienced an unfavourable outcome during hospitalisation. The frequency of unfavourable outcomes rose with increasing risk of acute deterioration as measured by the VIDA score. Risk factors independently associated with unfavourable outcomes were chronic underlying disease (OR: 1.90, 95% CI 1.32 to 2.72; p<0.001), mental status impairment (OR: 2.31, 95% CI 1.45 to 23.66; p<0.001), length of hospital stay (OR: 1.16, 95% CI 1.11 to 1.21; p<0.001) and high risk of acute deterioration (OR: 4.32, 95% CI 2.83 to 6.60; p<0.001). High-tech hospital admission was a protective factor against unfavourable outcomes (OR: 0.57, 95% CI 0.36 to 0.89; p=0.01).

Conclusion The systematic nursing surveillance of the status and evolution of COVID-19 inpatients, including the careful monitoring of acute deterioration risk and care complexity factors, may help reduce deleterious health outcomes in COVID-19 inpatients.

  • health informatics
  • health & safety
  • quality in health care
  • infectious diseases
  • respiratory infections
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2020-041726

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    Footnotes

    • Contributors All authors had full access to all study data and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: JA, MGS, MEJU. Coordination team: MEJU. Acquisition of data: JA, MTP, MMLJ, EZP, TCN. Analysis and interpretation of data: JA, MGS, EJM. Drafting of the manuscript: JA, MGS, EJM, MEJU. Critical revision of the manuscript for important intellectual content: MTP, MMLJ, HRF, EZP, TCN, JC. Statistical analysis: JA, MGS. Administrative, technical and material support: MMLJ, HRF. Study supervision: MEJU, JC.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This study was approved by the Clinical Research Ethics Committee of the Bellvitge University Hospital (reference 158/20). Informed consent was waived due to the study’s retrospective design. Ethical and data protection protocols related to anonymity and data confidentiality (access to records, data encryption and archiving of information) were complied with throughout the study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplemental information.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.