What Quality and Safety of Care for Patients Admitted to Clinically Inappropriate Wards: a Systematic Review

Regina, Micaela La; Guarneri, Francesca; Romano, Elisa; Orlandini, Francesco; Nardi, Roberto; Mazzone, Antonino; Fontanella, Andrea; Campanini, Mauro; Manfellotto, Dario; Bellandi, Tommaso; Gussoni, Gualberto; Tartaglia, Riccardo; Squizzato, Alessandro

doi:10.1007/s11606-019-05008-4

Cited by 30 publications

(39 citation statements)

References 24 publications

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“…These are novel findings among medicine wards as most prior studies have not demonstrated associations between bedspacing and LOS and have not investigated discharge to home as an outcome 1 2 11. Conversely, several studies have demonstrated associations between bedspacing and in-hospital mortality, which our study did not replicate 1 2. The differences in our findings may be due to a larger sample size, the differences between US hospitals and national health systems outside of the US and shorter LOS with higher post-acute care utilisation in the US compared with other countries 20 21…”

Section: Discussioncontrasting

confidence: 74%

“…Bedspacing is associated with increased hospital LOS and lower odds of discharge to home, which are associated with patient stress, discomfort and complication risks (eg, hospital-acquired infections, venous thromboembolic events, delirium and functional decline) 17–19. These are novel findings among medicine wards as most prior studies have not demonstrated associations between bedspacing and LOS and have not investigated discharge to home as an outcome 1 2 11. Conversely, several studies have demonstrated associations between bedspacing and in-hospital mortality, which our study did not replicate 1 2.…”

Section: Discussioncontrasting

confidence: 61%

“…For all analyses, we included hospital fixed effects to account for hospital-specific factors. Covariates for multivariable model adjustment were developed based on existing literature1–3 10 and included age, gender, race, ethnicity, insurance type, Elixhauser comorbidity scores, any time spent in an ICU, the Centers for Medicare and Medicaid Services (CMS) four-level severity risk adjustment (based on admitting diagnosis, demographics and comorbidities),14 15 admission diagnosis category (from International Classification of Disease-9 [ICD-9] and ICD-10 codes), daily mean number of medicine service patients by hospital during the hospitalisation, hospital admission source, season and if a hospital admission occurred during a weekend (table 1).…”

Section: Methodsmentioning

confidence: 99%

“…Specialty wards (eg, internal medicine) geographically cohort (ie, centralise) hospitalised patients to improve outcomes and lower costs 1–3. When demand exceeds capacity, patients overflow and are “bedspaced” to alternate wards rather than being “cohorted”.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have demonstrated that bedspacing among medicine service patients is associated with adverse patient-centred outcomes including prolonged LOS, clinical emergencies, in-hospital mortality and hospital readmissions, however, results have been inconsistent and these studies have primarily been performed outside of the United States (US) within national health systems 1–3 11–13. Therefore, our objective was to assess the association of bedspacing with patient-centred outcomes among a large population of US patients admitted to general medicine services in three diverse hospitals (ie, quaternary referral centre, tertiary referral centre and community hospital, with different patient demographics and case-mixes).…”

Section: Introductionmentioning

confidence: 99%

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Influence of bedspacing on outcomes of hospitalised medicine service patients: a retrospective cohort study

et al. 2020

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BackgroundSpecialty wards cohort hospitalised patients to improve outcomes and lower costs. When demand exceeds capacity, patients overflow and are “bedspaced” to alternate wards. Some studies have demonstrated that bedspacing among medicine service patients is associated with adverse patient-centred outcomes, however, results have been inconsistent and have primarily been performed within national health systems. The objective of this study was to assess the association of bedspacing with patient-centred outcomes among United States patients admitted to general medicine services.MethodsWe performed a retrospective cohort study of internal medicine, family medicine and geriatric service patients who were bedspaced vs cohorted for the entirety of their hospital stay within three large, urban United States hospitals (quaternary referral centre, tertiary referral centre and community hospital, with different patient demographics and case-mixes) in 2014 and 2015. We performed quantile regression to determine differences in length of stay (LOS) between bedspaced vs cohorted patients and logistic regression for in-hospital mortality and discharge to home.ResultsAmong 18 802 patients in 33 wards, 6119 (33%) patients were bedspaced. Bedspaced patients had significantly longer LOS compared with cohorted patients at the 25th (0.1 days, 95% CI: 0.05 to 0.2, p=0.001), 50th (0.2 days, 95% CI: 0.1 to 0.3, p=0.003) and 75th (0.3 days, 95% CI: 0.2 to 0.5, p<0.001) percentiles; and no statistically significant differences in odds of mortality (OR=0.9, 95% CI: 0.6 to 1.3, p=0.5) or discharge to home (OR=0.9, 95% CI: 0.9 to 1.0, p=0.06) in adjusted analyses.ConclusionBedspacing is associated with adverse patient-centred outcomes. Future work is needed to confirm these findings, understand mechanisms contributing to adverse outcomes and identify factors that mitigate these adverse effects in order to provide high-value, patient-centred care to hospitalised patients.

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Section: Discussioncontrasting

confidence: 74%

Section: Discussioncontrasting

confidence: 61%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Influence of bedspacing on outcomes of hospitalised medicine service patients: a retrospective cohort study

et al. 2020

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High ward occupancy, bedspacing, and 60 day mortality for patients with myocardial infarction, stroke, and heart failure

et al. 2022

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Aims To study the consequences of crowded wards among patients with cardiovascular disease. Methods and results This is a cohort study among 201 801 patients with 258 807 admissions who were acutely admitted for myocardial infarction (N = 107 895), stroke (N = 87 336), or heart failure (N = 63 576) to any Norwegian hospital between 2008 and 2016. The ward admitting most patients with the given clinical condition was considered a patient's home ward. We compared patients with the same condition admitted when home ward occupancy was different, at the same hospital and during comparable time periods. Occupancy was standardized such that a one‐unit difference corresponded to the interquartile range in occupancy in the given month. One interquartile increase in home ward occupancy was associated with 7% higher odds of admission to an alternate ward [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.09 to 1.11], and length of stay was shorter (−0.10 days, 95% CI −0.18 to −0.09). Patients with heart failure had 15% higher odds of admission to alternate wards (OR 1.15, 95% CI 1.08 to 1.23) and increased mortality [hazard ratio (HR) 1.08, 95% CI 1.03 to 1.15]. We found no apparent effect on mortality for patients with myocardial infarction (HR 0.99, 95% CI 0.94 to 1.05) or stroke (HR 1.00, 95% CI 0.96 to 1.05). Conclusions Patients with heart failure had higher risk of admission to alternate wards when home ward occupancy was high. These patients may be negatively affected by full wards.

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Bedspacing and clinical outcomes in general internal medicine: A retrospective, multicenter cohort study

Zannella

Jung

Fralick

et al. 2022

Journal of Hospital Medicine

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Background Admitting hospitalized patients to off‐service wards (“bedspacing”) is common and may affect quality of care and patient outcomes. Objective To compare in‐hospital mortality, 30‐day readmission to general internal medicine (GIM), and hospital length‐of‐stay among GIM patients admitted to GIM wards or bedspaced to off‐service wards. Design, Participants, and Measures Retrospective cohort study including all emergency department admissions to GIM between 2015 and 2017 at six hospitals in Ontario, Canada. We compared patients admitted to GIM wards with those who were bedspaced, using multivariable regression models and propensity score matching to control for patient and situational factors. Key Results Among 40,440 GIM admissions, 10,745 (26.6%) were bedspaced to non‐GIM wards and 29,695 (73.4%) were assigned to GIM wards. After multivariable adjustment, bedspacing was associated with no significant difference in mortality (adjusted hazard ratio 0.95, 95% confidence interval [CI]: 0.86–1.05, p = .304), slightly shorter median hospital length‐of‐stay (−0.10 days, 95% CI:−0.20 to −0.001, p = .047) and lower 30‐day readmission to GIM (adjusted OR 0.89, 95% CI: 0.83–0.95, p = .001). Results were consistent when examining each hospital individually and outcomes did not significantly differ between medical or surgical off‐service wards. Sensitivity analyses focused on the highest risk patients did not exclude the possibility of harm associated with bedspacing, although adverse outcomes were not significantly greater. Conclusions Overall, bedspacing was associated with no significant difference in mortality, slightly shorter hospital length‐of‐stay, and fewer 30‐day readmissions to GIM, although potential harms in high‐risk patients remain uncertain. Given that hospital capacity issues are likely to persist, future research should aim to understand how bedspacing can be achieved safely at all hospitals, perhaps by strengthening the selection of low‐risk patients.

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What Quality and Safety of Care for Patients Admitted to Clinically Inappropriate Wards: a Systematic Review

Cited by 30 publications

References 24 publications

Influence of bedspacing on outcomes of hospitalised medicine service patients: a retrospective cohort study

Influence of bedspacing on outcomes of hospitalised medicine service patients: a retrospective cohort study

High ward occupancy, bedspacing, and 60 day mortality for patients with myocardial infarction, stroke, and heart failure

Bedspacing and clinical outcomes in general internal medicine: A retrospective, multicenter cohort study

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