Key result
Restrictions on non-urgent hospital care during the SARS outbreak did not change mortality or readmission rates, despite an 11-37% decrease in invasive cardiac procedures for AMI patients.
Why the study?
Do restrictions on non-urgent hospital care impact short-term mortality and readmissions in seriously ill hospitalized patients?
Cohort
Yes
Do restrictions on non-urgent hospital care impact short-term mortality and readmissions in seriously ill hospitalized patients?
Restrictions on non-urgent hospital utilization during outbreaks appear to be a safe public health strategy without increasing short-term mortality or readmissions for seriously ill patients.
May support restricting non-urgent care during outbreaks without raising short-term mortality; leaves open generalizability to other settings or pandemics.
BACKGROUND: Restrictions on non-urgent hospital care imposed to control the 2003 Toronto severe acute respiratory syndrome outbreak led to substantial disruptions in hospital clinical practice, admission, and transfer patterns. OBJECTIVES: We assessed whether there were unintended health consequences to seriously ill hospitalized patients. STUDY DESIGN, SETTING, AND POPULATION: Population-based longitudinal cohort study of patients residing in Toronto or an urban control region with an incident admission for 1 of 7 serious conditions in the 3 years before, or the 4 months during or after restrictions. OUTCOME MEASURES: Short-term mortality, overall readmissions, cardiac readmissions for acute myocardial infarction patients, serious complications for very low birth weight babies, and quality of care measures, comparing adjusted rates across time periods within regions. RESULTS: Mortality, readmission, and complication rates did not change for any condition during or after severe acute respiratory syndrome restrictions. Although rates of invasive cardiac procedures for acute myocardial infarction patients decreased 11-37% in Toronto, rates of nonfatal cardiac outcomes did not change. CONCLUSIONS: Restrictions on non-urgent hospital utilization and hospital transfers may be a safe public health strategy to employ to control nosocomial outbreaks or provide hospital surge capacity for up to several months, in large, well-developed healthcare systems with good availability of community-based care.
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Stukel et al. (2008) conducted a cohort in Serious conditions requiring hospital admission. Restrictions on non-urgent hospital care vs. Urban control region and pre/post restriction periods was evaluated on Short-term mortality, overall readmissions, cardiac readmissions for acute myocardial infarction patients, serious complications for very low birth weight babies, and quality of care measures. Restrictions on non-urgent hospital care during the SARS outbreak did not change mortality or readmission rates, despite an 11-37% decrease in invasive cardiac procedures for AMI patients.
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