Quality Performance Evaluation of the Largest COVID-19-Designated Intensive Care Unit in the Western Region of Saudi Arabia

Ayman Morish; Abdulrahman Alsaigh; Ehab Almaghrabi; Huda Alenzi; Nizar M Ahmed; Ali AlAhdal

doi:10.7759/cureus.39800

Quality Performance Evaluation of the Largest COVID-19-Designated Intensive Care Unit in the Western Region of Saudi Arabia

Cureus. 2023 May 31;15(5):e39800. doi: 10.7759/cureus.39800. eCollection 2023 May.

Authors

Ayman Morish¹, Abdulrahman Alsaigh², Ehab Almaghrabi³, Huda Alenzi⁴, Nizar M Ahmed², Ali AlAhdal⁵

Affiliations

¹ Critical Care Medicine, Mediclinic Al Murjan Hospital, Jeddah, SAU.
² Integrated Care Outcome Management, Makkah Health Affairs, Makkah, SAU.
³ Forensic Medicine Department, Makkah Health Affairs, Makkah, SAU.
⁴ Nursing Administration, King Saud Medical City, Riyadh, SAU.
⁵ Integrated Healthcare Outcomes Management, Makkah Health Affairs, Makkah, SAU.

Abstract

Introduction Mortality is generally higher among patients with coronavirus disease 2019 (COVID-19) than non-COVID-19 patients, especially critically ill patients. The Acute Physiology and Chronic Health Evaluation IV (APACHE IV) predicts mortality rate (MR); however, it was not designed for COVID-19 patients. Multiple indicators have been utilized in healthcare to measure the performance of intensive care unit (ICU) departments, including length of stay (LOS) and MR. The 4C mortality score was recently developed using the ISARIC WHO clinical characterization protocol. This study aims to evaluate intensive care unit performance using LOS, MR, and 4C mortality scores at East Arafat Hospital (EAH), Makkah region, which is considered the largest COVID-19-designated intensive care unit in the Western region of Saudi Arabia. Materials and methods A retrospective observational cohort study was conducted on data from patients' records during the COVID-19 pandemic, from March 1, 2020, to October 31, 2021, at EAH, Makkah Health Affairs. Data to calculate LOS, MR, and 4C mortality scores were collected from the eligible patients' files by a trained team. Demographic (age and gender) and clinical data on admission were collected for statistical purposes. Results A total of 1298 patient records were included in the study; 417 (32%) of the patients were female and 872 (68%) were male. The cohort included 399 deaths (total MR=30.7%). Most deaths occurred in the 50-69-year age group, with significantly more deaths among female patients than male patients (p=0.004). A significant association was found between the 4C mortality score and death (p<0.000). Furthermore, the mortality odds ratio (OR) was significant (OR=1.3, 95% CI=1.178-1.447) for each added 4C score. Conclusion Our study metrics regarding LOS were generally higher than most internationally reported values and slightly lower than locally reported values. Our reported MR was comparable with overall published MRs. The ISARIC 4C mortality score was highly compatible with our reported MR between scores 4 and 14; however, the MR was higher for scores 0-3 and lower for scores ≤15. The overall performance of the ICU department was considered generally good. Our findings are helpful for benchmarking and motivating better outcomes.

Keywords: covid 19; covid-19 in saudi arabia; covid-19 infection; covid-19 outbreak; covid-19 outcome predictor; covid-19 pandemic; icu patients; impact of covid-19; medical icu; risk of covid-19 mortality.