The impact of the state of Ohio stay-at-home order on non-COVID-19 intensive care unit admissions and outcomes

Dear Editor,

Hospitals reported a decline in emergency room (ER) visits, hospitalisations, and elective procedures during the coronavirus disease 2019 (COVID-19) pandemic [1–4]. This raised concerns over delays in seeking care [5]. Cleveland Clinic, the largest healthcare system in northeast Ohio with its 10 hospitals witnessed a significant decline in ER visits and intensive care unit (ICU) admissions since the March 16 Ohio school closure order and the March 23 stay-at-home order by the Governor of Ohio. This study reviews non-COVID-19 patient ICU admissions and outcomes during the above social distancing measures.

We analysed the Cleveland Clinic health care system quality data registry for all non-COVID-19 ICU admissions from March 15 to April 30 2020. The Ohio stay-at-home order expired on May 1. This data was compared to the same period last year (2019). We collected demographics, ICU admission sources, hospital and ICU length of stay (LOS), hospital and ICU mortality, admission acute physiology score (APS), acute physiology and chronic health evaluation (APACHE III) score, and admission principal diagnosis to the ICU. Additionally, we collected Department of Health (DOH) in Ohio mortality data excluding COVID-19 for the months of March and April 2020 and compared those to the mortality counts and ratios for the same two months in 2019 for the seven counties in northeast Ohio where the 10 hospitals serve over 2.7 million population [6]. Two-sample t-test or Wilcoxon rank-sum test were used to compare continuous variables; the c2 test was applied to compare categorical variables. The institutional review board at the Cleveland Clinic approved this study and waived patient informed consent.

The number of patients presenting at all 10 hospital ERs from March 15 to April 30 2020 was 39,970, a decrease of 40.5% from 67,217 during the same period last year, with incidence rate ratio (IRR): 0.5946 (95% CI: 0.5873–0.6020). With universal COVID-19 testing for all admissions, ICU admissions for non-COVID-19 cases decreased by 38.1% from 2573 to 1592, IRR: 0.6187 (95% CI: 0.5812–0.6586). During the above same period the total number of ICU admissions of COVID-19-confirmed cases was 274, and the total overall number of hospitalised COVID-19-confirmed patients was 656. Table 1 summarises demographic and characteristic data for 2019 compared to 2020 for non-COVID-19 ICU admissions. Only the principal diagnosis on admission to...


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