key: cord-1024859-45i98xcc
authors: Rimmelé, Thomas; Pascal, Léa; Polazzi, Stéphanie; Duclos, Antoine
title: Organizational aspects of care associated with mortality in critically ill COVID-19 patients
date: 2020-10-06
journal: Intensive Care Med
DOI: 10.1007/s00134-020-06249-2
sha: 846ce271237a886b38343e321796b6188985dac4
doc_id: 1024859
cord_uid: 45i98xcc

nan

patient-related confounders, the risk of death increased among weekend ICU discharges (relative Risk 1.54, 95% CI 1.45-1.64). Patient mortality was also higher within ICUs located in the Paris (1.62, 1.35-1.94) and Northeast (1.24, 1.02-1.49) regions (Table 1) .

Three findings result from this large data analysis limited to available medical information that may not always consider all possible confounders accurately. First, weekends were associated with an increased likelihood of patient death at the end of ICU stay. Understaffing frequently occurs during weekends [3] and this result can be interpreted as a lack of available health professionals, given the patients' needs [4] . Second, excess mortality may arise when healthcare organizations are overwhelmed. Paris and Northeast regions exhibited by far the highest number of severe COVID-19 patients to treat in France and corresponding ICUs appeared to be rapidly saturated [5] . Finally, no learning curve for ICU management of COVID-19 patients was evidenced. A potential explanation is that "practice makes perfect" effect may be counterbalanced by high-volume of admissions leading to excessive workload and surpassing bed capacity to provide optimal care.

In the aftermath of the COVID-19 pandemic, ICU organizational aspects significantly influenced patient outcome. The capacity of healthcare systems to reshape quickly seems crucial to population survival in the context of health crises. Solutions to avoid overwhelming situations may include appropriate staffing, temporary units' openings, and close collaborations between ICUs from the same territory for optimal patient repartition. 

Managing ICU surge during the COVID-19 crisis: rapid guidelines

Extension of the modified Poisson regression model to prospective studies with correlated binary data

Patient mortality is associated with staff resources and workload in the ICU: a multicenter observational study

The weekend effect: does hospital mortality differ by day of the week? A systematic review and meta-analysis

Assistance Publique-Hôpitaux de Paris' response to the COVID-19 pandemic

All authors declare no conflicts of interest.

This observational study was based on anonymous data and declared to the National Data Protection Commission (MR-4423250520) before any analysis.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.Accepted: 15 September 2020

 1 Author contributions AD, LP, SP, and TR prepared this paper; AD and TR collaborated in the concept and design of the study; AD and TR was responsible for study governance and logistical support; all authors contributed substantially to analyzing and interpretation of data; AD and TR drafted the manuscript which then was critically revised by all the authors; All authors have read and approved the final manuscript.

None declared.