Understanding the effects of hospital capacity strain on quality of hospital care for patients admitted to medical and ICU wards during the pandemic and evaluating interventions to mitigate hospital capacity strain

COVID-19 placed significant strain on hospital capacity in Canada. We will study the effect of this strain on the quality of acute care for adult medical and intensive care unit (ICU) admissions, the two main locations of COVID-19 care and subsequent hospital strain. To mitigate capacity strain, Ontario hospitals engaged in inter-facility transfers of >3000 patients and extended ICU care onto medical wards. There is limited evidence about if these interventions were safe or effective for transferred patients or for critically ill patients cared for in a non-ICU setting. Little is known about how hospital strain, or the above interventions, impacted marginalized populations. Our research aims to investigate how hospital strain, and the two major capacity-mitigating interventions, affected quality of acute care for hospitalized medical and ICU patients. We will use data from GEMINI, a clinical and administrative data repository with data from 33 large hospitals across Ontario (~60% of Ontario's adult medical hospital beds), linked to population data at ICES. GEMINI is the largest clinical research dataset on hospitalized patients in Canada. First, we aim to characterize the effect of hospital strain on quality of care for medical and ICU patients. Then, we aim to investigate how large-scale inter-facility transfers and extension of ICU onto the ward affected clinical care. We will study prevalence and severity of both COVID-19 and non-COVID-19 hospitalizations, the impact on care for patients with chronic conditions, and the impact on marginalized groups (older adults, patients from marginalized neighborhoods). We will build a transfer optimization model that considers demographic, clinical and system factors to inform equitable and impactful inter-hospital patient transfers during future periods of hospital strain. Our results will help mitigate wider health consequences of hospital strain, promote equity, and increase the resilience of Canada's healthcare system.