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COVID-19 Insights & Analytics Issue 1

May 11, 2020

Overview

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The COVID-19 Patient Impact and Drug Stewardship Visualizations are designed to help quantify national trends and identify potential signals that reflect current clinical workflows and hospital operations on a national level during this pandemic. The included data and analytics are derived from electronic patient data from 338 participating U.S. hospitals. Data included was initiated on March 1, 2020 through May 3, 2020 unless otherwise indicated.

Executive Summary

  • COVID-19 testing & COVID-19 positives results occur in a broad age range of patients
  • Since elective surgeries and procedures were deferred in early March, we have seen a sharp decrease in inpatient bed utilization; however, the trend thereafter suggests a steady stream of admissions particularly in the last 4 weeks.
  • Higher levels of COVID-19 activity are associated with higher capacity utilization, but the trends tend to be similar among high, intermediate, and low COVID activity cohorts. A similar trend was initially seen with ICU admission, however the ICU admission trends have recently converged.

Testing Insights

Figure 1: Test positive by Age

Figure 1 Commentary:

  • Total test administered and % positive is highest for 51-60 age group
  • % positive is relatively similar for males & females in each age cohort
  • The distribution of positives tests is 48.2%/51.8% male/female, and females make up 57.0% of total specimens tested.
  • In contrast to reports from China & Italy, young patients (age 11-40) are also significantly testing positive. In this dataset, 25.7% of total positives are 40 or younger.

Figure 2: Test Turn-Around-Time (TAT)

Figure 2 Commentary:

  • Compared to prior weeks earlier in the pandemic, the COVID-19 lab test TAT (turn-around-time from collection to result) average has moved from approximately 3+ days to 1.5 days. This change could potentially reflect test volume shifting from “outside” agencies such as state department of public health or Reference Labs to “within system” testing.

Patient Acuity & Department Census Insights

Figure 3: Admission Demographics

Figure 3 Commentary:

  • COVID-19+ patients have longer overall Length of Stay (LOS) in both ICU and non-ICU locations compared to those who test negative. Both COVID-19 positive and negative patients stay longer than the average general population.

Figure 4: Hospital Admission compared to prior year maximum

Figure 4 Commentary:

  • Peak capacity was calculated by averaging the top 20 daily admissions in Calendar Year 2019, and each of the 3 Admissions graphs illustrate current day admissions as a percentage of calculated peak CY 2019 capacity.
  • Admissions were approximately 80% of peak capacity in early March. The decrease may be associated with the cancellation and delays of elective surgeries and procedures.
  • In general, the dips are functions of lower weekend admissions.
  • The last 6 weeks has seen a relatively flat level of peak admissions indicating a potential “plateauing” of national COVID activity.

Admissions Benchmark key

Top 20% of positive COVID specimens (High): Orange Line (n=56 hospitals)
Middle 60% of positive COVID specimens (Intermediate): Grey Line (n=150 hospitals)
Bottom 20% of positive COVID specimens (Low): Blue Line (n=45 hospitals)

Figure 5: ER Admission compared to prior year maximum

Figure 5 Commentary:

  • ER visits have been relatively constant throughout the last 6 weeks, even in high admit cohort.
  • The ER is typically less affected by delayed/cancelled elective surgeries and procedures compared to inpatient admissions.
  • Another factor in the initial overall decline in visits to ER may be due to patients with less serious choosing to stay away from COVID-19 high volume areas such as the ER during the pandemic.

Admissions Benchmark key

Top 20% of positive COVID specimens (High): Orange Line (n=56 hospitals)
Middle 60% of positive COVID specimens (Intermediate): Grey Line (n=150 hospitals)
Bottom 20% of positive COVID specimens (Low): Blue Line (n=45 hospitals)

Figure 6: ICU Admission compared to prior year maximum

Figure 6 Commentary:

  • Minimal difference is observed in ICU capacity utilization between High & Low hospital cohorts
  • This may be a sign of “ICU saturation,” and may not reflect creation of new temporary ICU areas (i.e. stepdown units or Operating Rooms converted to ICU beds)

Admissions Benchmark key

Top 20% of positive COVID specimens (High): Orange Line (n=56 hospitals)
Middle 60% of positive COVID specimens (Intermediate): Grey Line (n=150 hospitals)
Bottom 20% of positive COVID specimens (Low): Blue Line (n=45 hospitals)

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