Unexpected and Disruptive Changes in Admissions Associated with an Infectious-like Event Experienced at a Hospital in Berkshire, England around May of 2012

Abstract

Aims: To study the effect of a large infectious-like event on admissions to, and bed occupancy in, a very large acute hospital in Reading (western Berkshire) England, observed to commence in the early part of 2012. These changes occurred in parallel with infectious-like spread of an agent leading to increased medical admissions across the whole of Berkshire. Study Design: Longitudinal study of hospital admissions, bed occupancy and deaths. Place and Duration of Study: Admissions and deaths at the Royal Berkshire Hospital NHS Foundation Trust (England) between April 2008 and September 2013. Methodology: A running 12 month total of admissions, deaths and occupied beds was constructed from aggregated hospital admission and discharge data. Trends were analysed by admission type, discharge destination, specialty, International Classification of Diseases (ICD-10) primary diagnosis and Healthcare Resource Group (HRG) v4 chapter. Results: Admissions, deaths and occupied beds all showed a simultaneous step-like increase around March to June of 2012, which led to considerable operational pressure and a marked reduction in elective overnight surgery due to reduced bed availability. The increase in in-hospital deaths exhibited a curious time cascade which was specific for various diagnoses. Deaths first increased for those with cancers or intestinal conditions in January 2012, followed by hepatic, diabetic and asthma in February 2012, then a time series of other conditions, through to arthritis and arthrosis conditions in July 2012. All of these occurred at a time when deaths across the whole of the UK showed a large and unexpected increase. Conclusion: A new type of infectious event is strongly implicated which appears to exert its clinical effects via some form of immune impairment. The agent leads to a persistent infection. The immune modifying virus, cytomegalovirus, which (in other studies) is associated with a 20% higher odds ratio for all-cause mortality, has been circumstantially implicated, however, this requires confirmation.