Hospital out-lying through lack of beds and its impact on care and patient outcome

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Jean-Emmanuel de La Coussaye²  Alexandre Moreau²  Romain Genre Grandpierre²  Charlotte Boyard²  Xavier Bobbia²  Mustapha Sebbane¹  Pierre-Geraud Claret²  Andrew Stowell² 

[1] Structure des urgences, CHU de Montpellier, 191 Avenue du Doyen Giraud, Montpellier, 34295, France;Structure des urgences, CHU de Nîmes, place du Professeur Debré, Nîmes, 30029, France

关键词: Organization;    Hospitals;    Patient admission;    Hospital bed capacity;    Emergency service;   

Others  :  811629
DOI  :  10.1186/1757-7241-21-17

 received in 2012-10-22, accepted in 2013-02-14,  发布年份 2013

【 摘 要 】

Background

When medical wards become saturated, the common practice is to resort to outlying patients in another ward until a bed becomes free.

Objectives

Compare the quality of care provided for inpatients who are outlying (O) in inappropriate wards because of lack of vacant beds in appropriate specialty wards to the care given to non outlying (NO) patients.

Methods

We propose a matched-pair cluster study. The exposed group consisted of inpatients that were outliers in inappropriate wards because of lack of available beds. Non-exposed subjects (the control group) were those patients who were hospitalized in the ward that corresponded to the reason for their admission. Each patient of the exposed group was matched to a specific control subject. The principal objective was to prospectively measure differences in the length of hospital stays, the secondary objectives were to assess mortality, rate of re-admission at 28 days, and rate of transfer into intensive care.

Results

238 were included in the NO group, 245 in the O group. More patients in the O group (86% vs 76%) were transferred into a ward with prescription completed. O patients remained in hospital for 8 days [4-15] vs 7 days [4-13] for NO patients (p = 0.04). 124 (52%) of the NO patients received heparin-based thromboembolic prevention during their stay in hospital vs 104 (42%) of the O patient group (p = 0.03). 66 (27%) O patients were re-admitted to hospital within 28 days vs 40 (17%) NO patients (p = 0.008).

Conclusion

O patients had a worse prognosis than NO patients.

【 授权许可】

   
2013 Stowell et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Mira O, Antonio MT, Jimanez S: Decreased health care quality associated with emergency department overcrowding. Eur J Emerg Med 1999, 6(2):105-107.
• [2]Trzeciak S, Rivers EP: Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J 2003, 20(5):402-405.
• [3]Richardson DB: Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust 2006, 184(5):213-216.
• [4]Hwang U, Richardson L, Livote E: Emergency department crowding and decreased quality of pain care. Acad Emerg Med 2008, 15(12):1248-1255.
• [5]Cooke MW, Wilson S, Halsall J: Total time in English accident and emergency departments is related to bed occupancy. Emerg Med J 2004, 21(5):575-576.
• [6]Fatovich DM, Hirsch RL: Entry overload, emergency department overcrowding, and ambulance bypass. Emerg Med J 2003, 20(5):406-409.
• [7]Olshaker JS, Rathlev NK: Emergency Department overcrowding and ambulance diversion: the impact and potential solutions of extended out-lying of admitted patients in the Emergency Department. J Emerg Med 2006, 30(3):351-356.
• [8]Chrusch CA, Olafson KP, McMillan PM: High occupancy increases the risk of early death or readmission after transfer from intensive care. Crit Care Med 2009, 37(10):2753-2758.
• [9]Hillier DF, Parry GJ, Shannon MW, Stack AM: The effect of hospital bed occupancy on throughput in the pediatric emergency department. Ann Emerg Med 2009, 53(6):767-776. e3
• [10]Gilligan P, Winder S, Singh I: The Boarders in the Emergency Department (BED) study. Emerg Med J 2008, 25(5):265-269.
• [11]Richardson DB: The access-block effect: relationship between delay to reaching an inpatient bed and inpatient length of stay. Med J Aust 2002, 177(9):492-495.
• [12]Liew D, Liew D, Kennedy MP: Emergency department length of stay independently predicts excess inpatient length of stay. Med J Aust 2003, 179(10):524-526.
• [13]Viccellio A, Santora C, Singer AJ: The association between transfer of emergency department boarders to inpatient hallways and mortality: a 4-year experience. Ann Emerg Med 2009, 54(4):487-491.
• [14]Howell E, Bessman E, Marshall R: Hospitalist bed management effecting throughput from the emergency department to the intensive care unit. J Crit Care 2010, 25(2):184-189.
• [15]Sprivulis PC, Da Silva JA, Jacobs IG: The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. Med J Aust 2006, 184(5):208-212. Erratum in: Med J Aust. 2006 Jun 19;184(12):616
• [16]Lloyd JM, Elsayed S, Majeed A: The practice of out-lying patients is dangerous: a multicentre comparison study of nursing care provided for trauma patients. Injury 2005, 36(6):710-713.
• [17]Elsayed S, Cosker TD, Grant A: Pressure for beds–does it put our orthopaedic patients at risk? Injury 2005, 36(1):86-87.
• [18]Lepage B, Robert R, Lebeau M: Use of a risk analysis method to improve care management for out-lying inpatients in a university hospital. Qual Saf Health Care 2009, 18(6):441-445.
• [19]Alameda C, Suarez C: Clinical outcomes in medical outliers admitted to hospital with heart failure. Eur J Intern Med 2009, 20(8):764-767.
• [20]Marcantonio ER, McKean S, Goldfinger M: Factors associated with unplanned hospital readmission among patients 65 years of age and older in a Medicare managed care plan. Am J Med 1999, 107(1):13-17.
• [21]Covinsky KE, Palmer RM, Fortinsky RH: Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc 2003, 51(4):451-458.
• [22]Chu LW, Pei CK: Risk factors for early emergency hospital readmission in elderly medical patients. Gerontology 1999, 45(4):220-226.
• [23]Rodríguez-Artalejo F, Guallar-Castillón P, Herrera MC: Social network as a predictor of hospital readmission and mortality among older patients with heart failure. J Card Fail 2006, 12(8):621-627.
• [24]Strunin L, Stone M, Jack B: Understanding rehospitalization risk: can hospital discharge be modified to reduce recurrent hospitalization? J Hosp Med 2007, 2(5):297-304.
• [25]Huo MH, Spyropoulos AC: The eighth American college of chest physicians guidelines on venous thromboembolism prevention: implications for hospital prophylaxis strategies. J Thromb Thrombolysis 2011, 31(2):196-208.
• [26]Mahan CE, Spyropoulos AC: Venous thromboembolism prevention: a systematic review of methods to improve prophylaxis and decrease events in the hospitalized patient. Hosp Pract (Minneap) 2010, 38(1):97-108.
• [27]Cohen AT, Tapson VF, Bergmann JF: Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 2008, 371(9610):387-394. Erratum in: Lancet. 2008 Jun 7;371(9628):1914