Health impact of hospital restrictions on seriously ill hospitalized patients: lessons from the Toronto SARS outbreak.
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.


OBJECTIVE
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.


METHODS
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.
Stukel
Thérèse A
TA
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. stukel@ices.on.ca
Schull
Michael J
MJ
Guttmann
Astrid
A
Alter
David A
DA
Li
Ping
P
Vermeulen
Marian J
MJ
Manuel
Douglas G
DG
Zwarenstein
Merrick
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003428:Cross Infection / Q000517:prevention & control* / Q000635:transmission; D004196:Disease Outbreaks / Q000517:prevention & control*; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000706:statistics & numerical data; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D009864:Ontario; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011655:Pulmonary Embolism / Q000401:mortality / Q000628:therapy; D045169:Severe Acute Respiratory Syndrome / Q000517:prevention & control* / Q000635:transmission; D014600:Utilization Review / Q000706:statistics & numerical data