How Does a Pandemic Impact Patient Data?
A Snapshot of COVID-19’s Effect on Patient Progression
By Alex Bohn
COVID-19 struck the healthcare industry quickly and powerfully, forcing hospitals nationwide to enact strict measures to prevent the spread of the virus and prepare for the possible influx of high-acuity patients. Elective procedures were immediately canceled, outpatient offices closed or limited in scope, laboratory resources shifted, and the day-to-day operations of the facility turned upside down. No one could predict the impact that such an unprecedented event would have on operational and patient progression measures, and now, months in, we can start to form a picture of what healthcare organizations have experienced in the wake of the ongoing pandemic.
The Data below is from a Care Logistics customer base in 10 states for April and May 2020.
*All data is compared to the same period in 2019.
Acute Inpatient Days is a good place to begin since it is a straightforward measure to reflect a change in volume and census. On average, our hospitals saw a 16% decrease in acute inpatient days in April through May 2020, compared to 2019. The variability of this measure is high across hospitals, ranging from a 45% decrease to almost a 42% increase. May seemed to level off with a much smaller range. This is indicative of the regional effect that the early wave of COVID-19 had on the United States.
Acute Inpatient Discharges is a complementary measure to Inpatient Days and one we would expect to be severely impacted by the abrupt halt of elective procedures. Indeed, our customers experienced more than a 27% decrease in inpatient discharges. In April, every one of our hospitals experienced a double-digit percentage decrease except for one multi-hospital system in Long Island, NY.
Among the Long Island facilities, only one saw an increase in discharges compared to 2019. These declining trends continued into May but again appeared to be less severe.
Acute Inpatient Length of Stay (LOS) is another necessary piece of the puzzle and helps signify how inpatient progression has been affected by COVID-19. There are many influences on LOS, such as acuity, post-acute resource availability, census pressure, etc. New national and regional COVID requirements have impacted this measure even more, for instance requiring a negative COVID test in the last 72 hours before transferring to a post-acute facility.
We saw an average increase in Acute LOS of about 16% but with a high level of regional variability. This increase would be expected with the removal of generally shorter stay elective procedures and the high acuity of hospitalized COVID cases.
Case Mix Index (CMI) is the fourth and final measure related to inpatient care that we will include, as it reflects the acuity impact on Length of Stay. Again, the lack of elective procedures combined with very sick medical patients should result in an uptick in CMI. In fact, we received data showing a nearly 13% increase in CMI in April and May compared to the same period last year. Medical CMI increased more than Surgical CMI (24% compared to 13%, respectively). Yet again we see high variability by individual organizations in these measures, from a slight decrease to over 105% increase.
Observation-status patient performance is important to understand, in addition to inpatient management. Since a patient’s journey through a hospital generally ends up as either inpatient or observation, we need to analyze patients’ statused as Observation to get the full picture. Our facility subset predominantly saw a large drop in Obs visits compared to 2019, about 45% on average. Only one facility in Ohio had an increase in Obs volumes in April or May compared to the prior year.
Obs Length of Stay decreased only slightly on average, by about 4%. However, the variability in reported Observation LOS was large, suggesting that this average merely shows that hospitals saw Obs LOS increase or decrease in roughly equal proportion.
ED Visits is one measure in which we might not expect to see such a dramatic impact by COVID since the ED is the entry point for patients who need emergent care at that moment. However, studies are showing that patients are much less inclined to go to ED during the pandemic. A study of STEMI activations around the country showed a significant decrease through April, suggesting that patients are avoiding seeking care even when it is extremely life-threatening.
Every one of the hospitals in our data saw double-digit drops in ED Visits compared to last year, with an average of 40%.
Uncertainty is not uncommon in the world of healthcare, and the COVID-19 pandemic will likely be written about in history books as one of the most tumultuous worldwide events in living memory. Worldwide, healthcare organizations are looking for ways to plan and prepare for volatility. The more information that can be shared and studied about how organizations are weathering this storm, the better. The goal is greater preparedness and ultimately improved clinical and quality outcomes for patients, regardless of what is around the corner.