(1267) Time Spent on the Hospital Floor Before ICU Admission and Mortality Outcomes in COVID-19 Patients

Introduction: The COVID-19 pandemic has placed an immense burden on healthcare and understanding the factors that contribute to patient outcomes is crucial for improving care delivery. The present study aims to investigate the association between the duration of time spent on the hospital floor before Intensive Care Unit (ICU) admission and outcomes in COVID-19 patients.

Methods: A retrospective analysis was conducted on a cohort of COVID-19 patients admitted to the hospital between March 2020 and May 2023. Patient data, including demographics, comorbidities, acute physiologic scores (APS), APACHE IV scores, use of optiflow (OF), non-invasive positive pressure ventilation (NIPPV), need for intubation (INT), hospital length of stay (LOS) and hospital mortality were extracted from electronic medical records and APACHE Outcomes database. Patients were divided into two groups based on time spent on the hospital floor before admission to ICU: Group 1 spent less than 24 hours and Group 2 spent at least 24 hours to 96 hours on the hospital floor prior to admission to ICU. The primary outcome of interest was mortality.

Results: A total of 215 patients were analyzed (Group 1: 126; Group 2: 89). Compared to Group 1, Group 2 had similar age (64 +/- 15 vs 64 +/- 15, p = 1.0), BMI (32 +/- 10 vs 32 +/- 10, p = 1.0), number of comorbidities (3 +/- 2 vs 3 +/- 2, p = 1.0), APS (42 +/- 27 vs 45 +/- 27, p = 0.4), and APACHE IV (55 +/- 28 vs 56 +/- 30, p = 0.8). Group 2 had more OF (46 % vs 15 %, p = 0.0001), NIPPV (34 % vs 10 %, p = 0.0001), INT (51 % vs 36 %, p = 0.02), LOS (20 +/- 13 vs 15 +/- 18, p = 0.02), and higher mortality (52 % vs 27 %, p = 0.001).

Conclusions: The findings of this study suggest that early recognition of severe COVID-19 cases and prompt transfer to the ICU may be crucial in improving patient outcomes. Minimizing the time spent on the hospital floor before ICU admission could potentially reduce mortality in COVID-19 patients. These results highlight the importance of streamlined triage protocols, effective communication between healthcare providers, and resource allocation strategies to ensure timely access to critical care resources. Further research is warranted to explore the underlying mechanisms driving the association between time spent on the hospital floor before ICU admission and outcomes.