Hospital Policies During COVID-19 Pandemic Should Minimize Years of Life Lost

By Reuters Staff

September 10, 2021

(Reuters Health) - Health systems have prioritized COVID-19 patients for life-saving care during the pandemic, but a recent study suggests a different way to optimize scheduling and allocate beds to minimize years of life lost for all hospitalized patients.

In a paper published in Nature Computational Science, researchers use a dataset of administrative claims data from the National Health Service in the UK to examine how many more years of life might be gained by shifting priorities to consider putting the needs of certain patients ahead of those with COVID-19 in some circumstances. The study compared actual outcomes from March 2, 2020, to March 1, 2021, to hypothetical outcomes under a computational model they created to make the best use of limited resources.

Compared with typical hospital priorities during the pandemic, shifting focus in how hospitals schedule procedures, assign staff, use resources, and allocate beds might have gained an extra 50,750 to 5,891,608 years of life during the studied period, the authors calculate.

"Notable health gains are observed for neoplasms, diseases of the digestive system, and injuries and poisoning," the study team reports. "This approach minimizes years of life lost and is aligned with many policies put in place by the National Health Service in the UK to determine how to prioritize patients for treatment."

"Changes in prioritization rules can minimize the detrimental health impact of unprecedented hospital capacity shortages during the pandemic," the researchers argue. "It operationalizes the principles of best use of limited resources underlying the management of the English health system."

More broadly, the researchers say their model would be relevant to health systems elsewhere in the world that are working to reset priorities in hospital care and improve on stop-gap measures that focused on COVID-19 patients to the detriment of other patients.

In the model examined for this study, optimized schedules ration care when demand exceeds capacity. This is done by putting elective surgery patients on waiting lists until capacity arises, by treating critical care patients in general or acute wards until critical care capacity is available, and by considering the impact of denying admission to emergency patients.

Years of life lost were greater under standard pandemic policies than under shifted priorities with this model for most disease groups and most scenarios, the researchers calculate.

Optimizing schedules resulted in the biggest reduction in years of life lost in scenarios where capacity was most constrained and demand far exceeded available resources.

It helped to avoid blanket postponement of elective procedures and make these happen when openings could be filled from the wait list, the authors note. In worst case scenarios, both under pandemic policies and under model optimizing schedules, some patients required emergency treatment while awaiting procedures.

With an optimized schedule, critical care might be denied to 2.2% to 2.6% of patients over 52 weeks, the majority of whom are COVID-19 patients 65 years and older, researchers calculated. In the worst-case scenario, critical care might be denied to 4.8% to 6.4% of patients, most of whom would still be COVID-19 patients 65 years and older.

"The underlying assumption in NICE guidance, followed also internationally, is that the limited NHS budget should be used to maximize health outcomes, albeit using quality adjusted life years (QALYs) rather than years of life lost," the authors note.

SOURCE: Nature Computational Science, online August 13, 2021.