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Health Impact of Hospital Restrictions on Seriously Ill Hospitalized Patients: Lessons From the Toronto SARS Outbreak

Stukel, Thérèse A. PhD; Schull, Michael J. MD, MSc; Guttmann, Astrid MDCM, MSc; Alter, David A. MD, PhD; Li, Ping PhD; Vermeulen, Marian J. MHSc; Manuel, Douglas G. MD, MSc; Zwarenstein, Merrick MB, MSc, MSc(Med)

doi: 10.1097/MLR.0b013e3181792525
Brief Report

Background: Restrictions on nonurgent 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.

Objectives: 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.

Outcome Measures: 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 nonurgent 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.

From the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. Supported by a grant (SAR67804) from the Canadian Institutes of Health Research.

The study was approved by the Research Ethics Board of Sunnybrook Health Sciences Centre.

T.A.S. and M.J.S. conceived and designed the study, obtained funding, directed the analyses, and wrote the first draft of the paper. P.L. and M.J.V. prepared the data and performed the statistical analyses. All authors made substantial contributions to the conception and interpretation of the study, critically revised the manuscript, and approved the final version to be published.

Reprints: Thérèse A. Stukel, PhD, Institute for Clinical Evaluative Sciences 2075 Bayview Avenue, G106 Toronto, Ontario M4N 3M5, Canada. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.