PHILADELPHIA – Despite unchanging patient characteristics and severity of COVID-19, mortality rates for critically ill patients treated in the ICU for the virus progressively declined over time during the first surge of the pandemic, according to researchers in the Perelman School of Medicine at the University of Pennsylvania. The study suggests that clinicians and hospital staff rapidly improved their approach to managing the novel disease even before widespread use of evidence-based medications. The findings are published in the Annals of Internal Medicine.
Using data from 21 ICUs across 5 hospitals within Penn Medicine (the University of Pennsylvania Health System), researchers looked at the outcomes of patients with COVID-19 admitted over 15-day increments starting in March 2020 and ending in July 2020. During each consecutive period, mortality over a 28-day period decreased. In-hospital mortality for COVID ICU patients in the earliest period was 43.5 percent. By the last 15-day period in the study, mortality dropped to 19.2 percent despite patients having the same characteristics and severity of illness.
“These findings make us proud after a difficult year,” said co-lead author George L. Anesi, MD, MSCE, MBE, an instructor of Medicine in Pulmonary, Allergy, and Critical Care and co-chair of the Penn Medicine Critical Care Alliance COVID-19 and Pandemic Preparedness Committee. “COVID-19 remains a dangerous and deadly disease, but data suggests that our clinicians and front-line workers have quickly gained wisdom and practical knowledge from all of the experience and used that to help more critically ill patients survive.”
He notes that the work echoes other studies on mortality rates during the pandemic, suggesting that clinicians and providers are collectively improving their management of COVID.
At Penn, the multidisciplinary care teams leading the COVID response brought extensive training in care for individuals with highly-infectious respiratory diseases, which helped set a strong foundation at the outset of the pandemic. As cases of the virus grew across the Philadelphia region, those on the frontlines regularly met through the health system’s Critical Care Alliance COVID-19 Task Force to discuss their experiences, reflect on patient outcomes, and quickly assimilate new evidence aimed at standardizing approaches to ensure that each patient received the best possible care. Over a 10-week period at the onset of the pandemic, the Task Force released 15 clinical practice guidelines, a COVID-19 critical care admission order set for the electronic health record, surge location and staffing templates, equipment surveillance dashboards including for mechanical ventilators, and an online curriculum to cross-train non-ICU clinicians being re-deployed to surge locations.
“Our Critical Care Alliance immediately rose to the challenges of the pandemic, and through an iterative approach, our practice continues to evolve based on the evidence,” said co-lead author Juliane Jablonski, DNP, RN, a critical care systems strategist.
“Separate from the evidence-based medications we now have, we cannot yet say what specifically has made a difference, but it’s likely a combination of many adjustments and additions along with a commitment to constant reflection and the principles of critical care,” Anesi said.
The team is now planning research to identify what efforts have made the most substantial impact.
Co-senior authors of the study are Penn’s Brian J. Anderson, MD, MSCE, an associate medical director at the Hospital of the University of Pennsylvania, and Jacob T. Gutsche, MD, an associate professor of Anesthesiology and Critical Care.
The study was supported by the Agency for Healthcare Research and Quality (K12HS026372) and the National Institutes of Health (K23HL140482, K24HL115354, R00HL141678).