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Garattini L, Badinella Martini M, Mazzone A. Integrated care and lean management in internal medicine: An ideal mix for a functioning health system? Eur J Intern Med 2024:S0953-6205(24)00324-8. [PMID: 39054186 DOI: 10.1016/j.ejim.2024.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 07/19/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Livio Garattini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy.
| | - Marco Badinella Martini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - Antonino Mazzone
- Department of Internal Medicine, Legnano and Magenta Hospitals, ASST Ovest Milanese, Legnano, MI, Italy
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Waqas M, Xu SH, Hussain S, Aslam MU. Control charts in healthcare quality monitoring: a systematic review and bibliometric analysis. Int J Qual Health Care 2024; 36:mzae060. [PMID: 39018022 DOI: 10.1093/intqhc/mzae060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 06/21/2024] [Accepted: 07/16/2024] [Indexed: 07/18/2024] Open
Abstract
Control charts, used in healthcare operations to monitor process stability and quality, are essential for ensuring patient safety and improving clinical outcomes. This comprehensive research study aims to provide a thorough understanding of the role of control charts in healthcare quality monitoring and future perspectives by utilizing a dual methodology approach involving a systematic review and a pioneering bibliometric analysis. A systematic review of 73 out of 223 articles was conducted, synthesizing existing literature (1995-2023) and revealing insights into key trends, methodological approaches, and emerging themes of control charts in healthcare. In parallel, a bibliometric analysis (1990-2023) on 184 articles gathered from Web of Science and Scopus was performed, quantitatively assessing the scholarly landscape encompassing control charts in healthcare. Among 25 countries, the USA is the foremost user of control charts, accounting for 33% of all applications, whereas among 14 health departments, epidemiology leads with 28% of applications. The practice of control charts in health monitoring has increased by more than one-third during the last 3 years. Globally, exponentially weighted moving average charts are the most popular, but interestingly the USA remained the top user of Shewhart charts. The study also uncovers a dynamic landscape in healthcare quality monitoring, with key contributors, research networks, research hotspot tendencies, and leading countries. Influential authors, such as J.C. Benneyan, W.H. Woodall, and M.A. Mohammed played a leading role in this field. In-countries networking, USA-UK leads the largest cluster, while other clusters include Denmark-Norway-Sweden, China-Singapore, and Canada-South Africa. From 1990 to 2023, healthcare monitoring evolved from studying efficiency to focusing on conditional monitoring and flowcharting, with human health, patient safety, and health surveys dominating 2011-2020, and recent years emphasizing epidemic control, COronaVIrus Disease of 2019 (COVID-19) statistical process control, hospitals, and human health monitoring using control charts. It identifies a transition from conventional to artificial intelligence approaches, with increasing contributions from machine learning and deep learning in the context of Industry 4.0. New researchers and journals are emerging, reshaping the academic context of control charts in healthcare. Our research reveals the evolving landscape of healthcare quality monitoring, surpassing traditional reviews. We uncover emerging trends, research gaps, and a transition in leadership from established contributors to newcomers amidst technological advancements. This study deepens the importance of control charts, offering insights for healthcare professionals, researchers, and policymakers to enhance healthcare quality. Future challenges and research directions are also provided.
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Affiliation(s)
- Muhammad Waqas
- School of Mathematics and Statistics, Xi'an Jiaotong University, XJTU, Xian, Shaanxi 710049, China
- Department of Statistics, University of Wah, Taxila, Punjab 47040, Pakistan
| | - Song Hua Xu
- Department of Health Management & Institute of Medical Artificial Intelligence, The Second Affiliated Hospital, Xi'an Jiaotong University, XJTU, Xian, Shaanxi 710049, China
- Department of Computer Science, Yale University, New Haven, CT 06511, United States
| | - Sajid Hussain
- School of Mathematics and Statistics, Xi'an Jiaotong University, XJTU, Xian, Shaanxi 710049, China
| | - Muhammad Usman Aslam
- School of Mathematics and Statistics, Xi'an Jiaotong University, XJTU, Xian, Shaanxi 710049, China
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Mazzone A, Montano N. Admission in Internal Medicine: The Italian issue. Eur J Intern Med 2024; 124:143-144. [PMID: 38462417 DOI: 10.1016/j.ejim.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/19/2024] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Affiliation(s)
- Antonino Mazzone
- ASST OVEST MILANESE, Via Papa Giovanni Paolo II, 20025 Legnano MI, Italy.
| | - Nicola Montano
- Department of Clinical Sciences and Community Health, University of Milan IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, 20121 Milano, Italy
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Uchmanowicz I, Lisiak M, Wleklik M, Pawlak AM, Zborowska A, Stańczykiewicz B, Ross C, Czapla M, Juárez-Vela R. The Impact of Rationing Nursing Care on Patient Safety: A Systematic Review. Med Sci Monit 2024; 30:e942031. [PMID: 38196186 PMCID: PMC10787575 DOI: 10.12659/msm.942031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Rationing of nursing care (RONC) has been associated with poor patient outcomes and is a growing concern in healthcare. The aim of this systematic study was to investigate the connection between patient safety and the RONC. MATERIAL AND METHODS A thorough search of electronic databases was done to find research that examined the relationship between restricting nurse services and patient safety. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers (M.L. and A.P.) independently screened the titles and abstracts, and full-text articles were assessed for eligibility. Data were extracted, and a quality assessment was performed using appropriate techniques. RESULTS A total of 15 studies met the inclusion criteria. The studies included in the review demonstrated a correlation between rationing of nursing care and patient safety. The results of these studies revealed that there is an inverse relationship between rationing of nursing care and patient safety. The review found that when nursing care is rationed, there is a higher incidence of falls, medication errors, pressure ulcers, infections, and readmissions. In addition, the review identified that the work characteristics of nurses, such as workload, staffing levels, and experience, were associated with RONC. CONCLUSIONS RONC has a negative impact on patient safety outcomes. It is essential for healthcare organizations to implement effective strategies to prevent the RONC. Improving staffing levels, workload management, and communication amo0ng healthcare providers are some of the strategies that can support this.
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Affiliation(s)
- Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Magdalena Lisiak
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
- Institute of Heart Diseases, University Hospital, Wrocław, Poland
| | - Marta Wleklik
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
- Institute of Heart Diseases, University Hospital, Wrocław, Poland
| | - Andrzej Maciej Pawlak
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Agnieszka Zborowska
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Bartłomiej Stańczykiewicz
- Division of Consultation Psychiatry and Neuroscience, Department of Psychiatry, Wrocław Medical University, Wrocław, Poland
| | - Catherine Ross
- The Centre for Cardiovascular Health, School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Michał Czapla
- Institute of Heart Diseases, University Hospital, Wrocław, Poland
- Department of Emergency Medical Service, Wrocław Medical University, Wrocław, Poland
- Group of Research in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, Logroño, Spain
| | - Raúl Juárez-Vela
- Group of Research in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, Logroño, Spain
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Jones RP. Addressing the Knowledge Deficit in Hospital Bed Planning and Defining an Optimum Region for the Number of Different Types of Hospital Beds in an Effective Health Care System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7171. [PMID: 38131722 PMCID: PMC11080941 DOI: 10.3390/ijerph20247171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
Based upon 30-years of research by the author, a new approach to hospital bed planning and international benchmarking is proposed. The number of hospital beds per 1000 people is commonly used to compare international bed numbers. This method is flawed because it does not consider population age structure or the effect of nearness-to-death on hospital utilization. Deaths are also serving as a proxy for wider bed demand arising from undetected outbreaks of 3000 species of human pathogens. To remedy this problem, a new approach to bed modeling has been developed that plots beds per 1000 deaths against deaths per 1000 population. Lines of equivalence can be drawn on the plot to delineate countries with a higher or lower bed supply. This method is extended to attempt to define the optimum region for bed supply in an effective health care system. England is used as an example of a health system descending into operational chaos due to too few beds and manpower. The former Soviet bloc countries represent a health system overly dependent on hospital beds. Several countries also show evidence of overutilization of hospital beds. The new method is used to define a potential range for bed supply and manpower where the most effective health systems currently reside. The method is applied to total curative beds, medical beds, psychiatric beds, critical care, geriatric care, etc., and can also be used to compare different types of healthcare staff, i.e., nurses, physicians, and surgeons. Issues surrounding the optimum hospital size and the optimum average occupancy will also be discussed. The role of poor policy in the English NHS is used to show how the NHS has been led into a bed crisis. The method is also extended beyond international benchmarking to illustrate how it can be applied at a local or regional level in the process of long-term bed planning. Issues regarding the volatility in hospital admissions are also addressed to explain the need for surge capacity and why an adequate average bed occupancy margin is required for an optimally functioning hospital.
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Thompkins S, Schaefer S, Toh D, Horwood C, Thompson CH. Outlier or handover: outcomes for General Medicine inpatients. AUST HEALTH REV 2023; 47:602-606. [PMID: 37640381 DOI: 10.1071/ah22242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
Objective Patients admitted from the emergency department may be co-located on the treating team's 'home ward'. If no bed is available, patients may be sent to another ward, where they may remain under the admitting team as an 'outlier'. Conversely, care may be handed over to the team on whose home ward they are located. We conducted a retrospective analysis to understand the impact of outlier status and handovers of care on outcomes for General Medicine inpatients. Methods General Medicine admissions at the Royal Adelaide Hospital between September 2020 and November 2021 were analysed. We examined the rate of hospital-acquired complications, inpatient mortality rate, mortality within 48 h of admission, Relative Stay Index, time of discharge from hospital and rate of adverse events within 28 days of discharge. Results A total of 3109 admissions were analysed. Handovers within 24 h of admission were associated with a longer length of stay. There was a trend towards higher rates of adverse events within 28 days of discharge with handovers of care. Outlier status did not affect any outcome measures. Conclusions Handovers within the first 24 h of admission are associated with longer than expected length of stay.
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Affiliation(s)
- S Thompkins
- Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - S Schaefer
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - D Toh
- Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - C Horwood
- Southern Adelaide Local Health Network, Bedford Park, SA, Australia
| | - C H Thompson
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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Rowberry R, Mortimore G. Septic pulmonary emboli: a case discussion. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:832-838. [PMID: 37737857 DOI: 10.12968/bjon.2023.32.17.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
A septic pulmonary embolus occurs from the embolisation of an infected thrombus - typically from an infected source such as an abscess - that enters the venous circulation, implanting in the lungs, which in turn causes a parenchymal infection. This case discussion gives a candid reflection on the treatment and management of a patient who was a known intravenous drug user, with a past history of a deep vein thrombosis and new presentation of a groin abscess. He was initially reviewed by a trainee advanced clinical practitioner, working out of hours in a hospital setting. This article will reflect on the patient presentation, the clinical examinations and investigations undertaken, which finally led to the diagnosis of septic pulmonary emboli. Although this condition is rare, having a high index of suspicion in patients with known risk factors may lead to early diagnosis and successful treatment.
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Affiliation(s)
- Rowena Rowberry
- Lecturer, Department of Health, Psychology and Social Care, University of Derby
| | - Gerri Mortimore
- Lecturer, Department of Health, Psychology and Social Care, University of Derby
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8
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Mendelsohn E, Honeyford K, Brittin A, Mercuri L, Klaber RE, Expert P, Costelloe C. The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study. Sci Rep 2023; 13:15417. [PMID: 37723183 PMCID: PMC10507077 DOI: 10.1038/s41598-023-41966-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 09/04/2023] [Indexed: 09/20/2023] Open
Abstract
The architectural design of hospitals worldwide is centred around individual departments, which require the movement of patients between wards. However, patients do not always take the simplest route from admission to discharge, but can experience convoluted movement patterns, particularly when bed availability is low. Few studies have explored the impact of these rarer, atypical trajectories. Using a mixed-method explanatory sequential study design, we firstly used three continuous years of electronic health record data prior to the Covid-19 pandemic, from 55,152 patients admitted to a London hospital network to define the ward specialities by patient type using the Herfindahl-Hirschman index. We explored the impact of 'regular transfers' between pairs of wards with shared specialities, 'atypical transfers' between pairs of wards with no shared specialities and 'site transfers' between pairs of wards in different hospital site locations, on length of stay, 30-day readmission and mortality. Secondly, to understand the possible reasons behind atypical transfers we conducted three focus groups and three in-depth interviews with site nurse practitioners and bed managers within the same hospital network. We found that at least one atypical transfer was experienced by 12.9% of patients. Each atypical transfer is associated with a larger increase in length of stay, 2.84 days (95% CI 2.56-3.12), compared to regular transfers, 1.92 days (95% CI 1.82-2.03). No association was found between odds of mortality, or 30-day readmission and atypical transfers after adjusting for confounders. Atypical transfers appear to be driven by complex patient conditions, a lack of hospital capacity, the need to reach specific services and facilities, and more exceptionally, rare events such as major incidents. Our work provides an important first step in identifying unusual patient movement and its impacts on key patient outcomes using a system-wide, data-driven approach. The broader impact of moving patients between hospital wards, and possible downstream effects should be considered in hospital policy and service planning.
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Affiliation(s)
| | | | | | - Luca Mercuri
- Information Communications and Technology Department, Imperial College Healthcare NHS Trust, London, UK
| | - Robert Edward Klaber
- Department of Paediatrics, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Academic Centre for Paediatrics and Child Health, Imperial College London, London, UK
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Hsuan C, Segel JE, Hsia RY, Wang Y, Rogowski J. Association of emergency department crowding with inpatient outcomes. Health Serv Res 2023; 58:828-843. [PMID: 36156243 PMCID: PMC10315392 DOI: 10.1111/1475-6773.14076] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To examine the association of higher emergency department (ED) census with inpatient outcomes on the day of discharge (inpatient length of stay, in-hospital mortality, ED revisits, and readmissions). DATA SOURCES AND STUDY SETTING All-payer ED and inpatient discharge data and hospital characteristics data from all non-federal, general, and acute care hospitals in the state of California from October 1, 2015 to December 31, 2017. STUDY DESIGN In retrospective data analysis, we examined whether ED census was associated with inpatient outcomes for all inpatients, including those not admitted through the ED. The main predictor variable was ED census on day of discharge, categorized based on hospital year and day of week. Separate linear regression models with robust SEs and hospital fixed effects examined the association of ED census on inpatient outcomes (length of stay, 3-day ED revisit, 30-day all-cause readmission, in-hospital mortality), controlling for patient and visit-level factors. We stratified analyses by whether admission was elective or unscheduled. EXTRACTION METHODS Inpatient discharges in non-federal, general medical hospitals with EDs. PRINCIPAL FINDINGS We examined 5,784,253 discharges. The adjusted model showed that, compared to when the ED was below the median, higher ED census on the day of discharge was associated with longer inpatient length of stay, lower readmissions, and higher in-hospital mortality (90th percentile for length of stay: +0.8% [95% confidence interval, CI: +0.6% to +1.1%]; readmissions: -0.59 percentage points [or -5.6%] [95% CI: -0.0071 to -0.0048]; mortality: +0.14 percentage points [or +5.4%] [95% CI: +0.0009 to +0.0018]). [Correction added on 18 November 2022, after first online publication: '[odds rato, OR -5.6%]' and '[OR +5.4%]' of the preceding sentence have been corrected to '[or -5.6%]' and '[or +5.4%]', respectively, in this version.] Results for length of stay were primarily driven by patients with elective admissions, while results for readmissions and in-hospital mortality were primarily driven by patients with unscheduled admissions. CONCLUSIONS This study suggests that ED crowding may affect inpatients throughout the hospital, even patients who are already admitted to the hospital.
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Affiliation(s)
- Charleen Hsuan
- Department of Health Policy and AdministrationPennsylvania State UniversityState CollegePennsylvaniaUSA
| | - Joel E. Segel
- Department of Health Policy and AdministrationPennsylvania State UniversityState CollegePennsylvaniaUSA
- Penn State Cancer InstituteHersheyPennsylvaniaUSA
- Department of Public Health SciencesPennsylvania State UniversityState CollegePennsylvaniaUSA
| | - Renee Y. Hsia
- Department of Emergency MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Yinan Wang
- Department of Health Policy and AdministrationPennsylvania State UniversityState CollegePennsylvaniaUSA
| | - Jeannette Rogowski
- Department of Health Policy and AdministrationPennsylvania State UniversityState CollegePennsylvaniaUSA
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Harhara T, Ibrahim H, Gaba WH, Kamour AM. Development of an acute medical unit to optimize patient flow and early discharges in a tertiary care hospital in the United Arab Emirates. BMC Health Serv Res 2022; 22:1447. [PMID: 36447224 PMCID: PMC9708119 DOI: 10.1186/s12913-022-08746-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/27/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Hospitals worldwide are seeing an increased number of acute admissions, with resultant emergency department (ED) crowding and increased length of stay (LOS). Acute Medical Units (AMUs) have developed throughout the United Kingdom and other Western countries to reduce the burden on EDs and improve patient flow. Limited information is available on AMUs in the Middle East. The purpose of this study is to describe the development of the first AMU in the United Arab Emirates (UAE) for general medical patients and its impact on LOS, early discharges, ED boarders, and readmission rates. METHODS We established a consultant-led AMU in a tertiary hospital in the UAE. A retrospective comparative review of all general medical admissions to the AMU between August 1, 2020 and December 31, 2020 and all admissions to the traditional medical wards between August 1, 2019 and December 31, 2019 was conducted. RESULTS The average LOS reduced from 10 to 5 days (95% CI [4.14-6.25], p < 0.001) after the introduction of AMU. Early discharges increased by 22%. The number of outliers and number of patients boarding in ED reduced significantly (111 in 2019 vs. 60 in 2020, p < 0.05; 938 in 2019 vs. 104 in 2020, p < 0.001 respectively), with a decrease in ED waiting time from 394 min to 134 min (95% CI [229.25-290.75], p < 0.001). There was no increase in 30-day readmission rates. CONCLUSION Restructuring the system of care can reduce LOS, overcome discharge barriers and improve patient flow. Similar units can be developed in hospitals throughout the UAE and the region to reduce LOS and improve patient flow through acute care units.
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Affiliation(s)
- Thana Harhara
- grid.415670.10000 0004 1773 3278Department of Medicine, Sheikh Khalifa Medical City, PO Box 51900, Abu Dhabi, United Arab Emirates
| | - Halah Ibrahim
- grid.440568.b0000 0004 1762 9729Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates
| | - Waqar H. Gaba
- grid.415670.10000 0004 1773 3278Department of Medicine, Sheikh Khalifa Medical City, PO Box 51900, Abu Dhabi, United Arab Emirates
| | - Ashraf M. Kamour
- grid.415670.10000 0004 1773 3278Department of Medicine, Sheikh Khalifa Medical City, PO Box 51900, Abu Dhabi, United Arab Emirates
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11
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Asheim A, Nilsen SM, Aam S, Anthun KS, Carlsen F, Janszky I, Vatten LJ, Bjørngaard JH. High ward occupancy, bedspacing, and 60 day mortality for patients with myocardial infarction, stroke, and heart failure. ESC Heart Fail 2022; 9:1884-1890. [PMID: 35345059 PMCID: PMC9065853 DOI: 10.1002/ehf2.13894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/14/2022] [Accepted: 03/02/2022] [Indexed: 11/20/2022] Open
Abstract
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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Affiliation(s)
- Andreas Asheim
- Center for Health Care Improvement, St. Olav's Hospital HF, Trondheim University Hospital, Trondheim, Norway.,Department of Mathematical Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sara Marie Nilsen
- Center for Health Care Improvement, St. Olav's Hospital HF, Trondheim University Hospital, Trondheim, Norway
| | - Stina Aam
- Department of Geriatric Medicine, Clinic of Medicine, St. Olav's Hospital HF, Trondheim University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjartan Sarheim Anthun
- Department of Public Health and Nursing, Norwegian University of Science and Technology, PO Box 8905, Trondheim, 7491, Norway.,Department of Health Research, SINTEF Digital, Trondheim, Norway
| | - Fredrik Carlsen
- Department of Economics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Imre Janszky
- Center for Health Care Improvement, St. Olav's Hospital HF, Trondheim University Hospital, Trondheim, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology, PO Box 8905, Trondheim, 7491, Norway
| | - Lars Johan Vatten
- Department of Public Health and Nursing, Norwegian University of Science and Technology, PO Box 8905, Trondheim, 7491, Norway
| | - Johan Håkon Bjørngaard
- Department of Public Health and Nursing, Norwegian University of Science and Technology, PO Box 8905, Trondheim, 7491, Norway.,Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
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12
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Zannella VE, Jung HY, Fralick M, Lapointe-Shaw L, Liu JJ, Weinerman A, Kwan J, Tang T, Rawal S, MacMillan TE, Bai AD, Gill S, Shi J, Bell CM, Razak F, Verma AA. Bedspacing and clinical outcomes in general internal medicine: A retrospective, multicenter cohort study. J Hosp Med 2022; 17:3-10. [PMID: 35504572 DOI: 10.1002/jhm.2734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/11/2022]
Abstract
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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Affiliation(s)
| | - Hae Y Jung
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Michael Fralick
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Lauren Lapointe-Shaw
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Jessica J Liu
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Adina Weinerman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Janice Kwan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Terence Tang
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Shail Rawal
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Thomas E MacMillan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Anthony D Bai
- Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
| | - Sudeep Gill
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Jiamin Shi
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Chaim M Bell
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Fahad Razak
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Amol A Verma
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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13
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Nymark C, von Vogelsang AC, Falk AC, Göransson KE. Patient safety, quality of care and missed nursing care at a cardiology department during the COVID-19 outbreak. Nurs Open 2021; 9:385-393. [PMID: 34569190 PMCID: PMC8661578 DOI: 10.1002/nop2.1076] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/13/2021] [Accepted: 09/08/2021] [Indexed: 12/25/2022] Open
Abstract
Aim To evaluate missed nursing care and patient safety during the first wave of the COVID‐19 pandemic at in‐patient cardiology wards. Design A cross‐sectional design with a comparative approach. Method Registered nurses and nurse assistants at a cardiology department were invited to answer the MISSCARE Survey‐Swedish version, and questions on patient safety and quality of care during the COVID‐19 pandemic. The data were compared with a reference sample. Results A total of 43 registered nurses and nurse assistants in the COVID‐19 sample and 59 in the reference sample participated. The COVID‐19 sample reported significantly more overtime hours and more absence from work due to illness in comparison with the reference sample. The patient safety and quality of care were perceived significantly worse, 76.7% (N = 33) versus 94.7% (N = 54), and 85.7% (N = 36) versus 98.3% (N = 58, respectively. The COVID‐19 sample reported more missed nursing care in wound care and in basic nursing.
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Affiliation(s)
- Carolin Nymark
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ann-Christin von Vogelsang
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ann-Charlotte Falk
- Department for Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Katarina E Göransson
- Emergency and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
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14
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Patry C, Perozziello A, Pardineille C, Aubert C, de Malglaive P, Choquet C, Raynaud-Simon A, Sanchez M. Older medical outliers on surgical wards: impact on 6-month outcomes. Emerg Med J 2021; 39:181-185. [PMID: 34140319 DOI: 10.1136/emermed-2020-210192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 05/17/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Medical patients are on occasion admitted transiently to surgical wards when more appropriate wards are at capacity, potentially leading to suboptimal care. The aim of this study was to compare 6-month outcomes in older adults diagnosed with medical conditions in the ED then admitted inappropriately to surgical wards (defined as outliers), with outcomes in comparable patients admitted to medical wards (controls). METHODS In a matched cohort study, 100 consecutive medical outliers from the ED aged 75 years and over were matched according to age, sex and diagnosis to 200 controls. Collected data included number of diagnoses reported in acute care, level of patient illness severity, length of stay, mortality and destination of patients discharged from acute care units (home, rehabilitation facility, nursing home or palliative care facility). An assessment was made of patient vital status and living environment (home, nursing home or hospital) at 6 months post-ED admission. RESULTS Mean age was 85.6 years. The most common ED diagnoses were gait disorders/falls (18%), neurological disorders (17%) and exhaustion (16%). Outliers displayed lower illness severity levels (0.001) and shorter lengths of stay from ED admission to acute care discharge (p=0.040). Subsequent to acute care, outliers were less commonly discharged home (45% vs 59%) and more commonly discharged to rehabilitation facilities (42% vs 28%). At 6 months post-ED admission, multivariable regression analysis showed that outlier status (OR=0.44 (0.25-0.83); p=0.011) and numbers of diagnoses reported in acute care (OR=0.87 (0.76-0.98); p=0.028) were independently associated with lower probability of living at home. CONCLUSION Outlying of older patients to surgical wards negatively affects their prospects of living at home at 6 months after hospital admission. Older patients hospitalised via the ED are entitled to appropriate medical care.
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Affiliation(s)
- Claire Patry
- Geriatric Department, Bichat University Hospital, Assistance Publique - Hopitaux de Paris (APHP), Paris, France
| | - Anne Perozziello
- Health Information Management Department, Bichat University Hospital, Assistance Publique - Hopitaux de Paris (APHP), Paris, France
| | - Clio Pardineille
- Geriatric Department, Sainte-Périne University Hospital, Assistance Publqiue - Hopitaux de Paris (APHP), Paris, France
| | - Christiane Aubert
- Geriatric Department, Bichat University Hospital, Assistance Publique - Hopitaux de Paris (APHP), Paris, France
| | - Pauline de Malglaive
- Geriatric Department, Bichat University Hospital, Assistance Publique - Hopitaux de Paris (APHP), Paris, France
| | - Christophe Choquet
- Emergency Department - Bichat University Hospital, Assistance Publique - Hopitaux de Paris (APHP), Paris, France
| | - Agathe Raynaud-Simon
- Geriatric Department, Bichat University Hospital, Assistance Publique - Hopitaux de Paris (APHP), Paris, France.,University of Paris, Paris, France
| | - Manuel Sanchez
- Geriatric Department, Bichat University Hospital, Assistance Publique - Hopitaux de Paris (APHP), Paris, France .,University of Paris, Paris, France
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15
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Bogler O, Liu J, Cadesky B, Bell CM. Quality of care and outcomes in internal medicine patients bedspaced to noninternal medicine units. Medicine (Baltimore) 2021; 100:e25737. [PMID: 33950957 PMCID: PMC8104304 DOI: 10.1097/md.0000000000025737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/25/2021] [Indexed: 01/04/2023] Open
Abstract
Hospital overcrowding has led to a practice known as bedspacing (in which admitted patients are placed on a different specialty's inpatient ward), yet little is known about the impact of this practice on healthcare quality.We investigated whether hospital outcome measures differ between bedspaced general internal medicine (GIM) patients vs nonbedspaced patients.Our retrospective study included patients admitted to GIM wards at 2 academic hospitals (2012-2014), comparing bedspaced to nonbedspaced patients, and identifying adverse events from the hospital's Electronic Patient Record.We compared these groups with respect to actual length of stay vs the expected length of stay (% ELOS), which is defined as length of stay (LOS) divided by expected length of stay (ELOS), 30-day readmission, adverse events (falls, medication-related incidents, equipment-related incidents, first treatment related incidents, laboratory-related incidents, and operative/invasive events), and in-hospital mortality.There were 22,519 patients analyzed with 15,985 (71%) discharged from a medical ward and 6534 (29%) discharged from a non-medical ward. Bedspaced patients had shorter lengths of stay (4.1 vs 6.2 days, P < .001) and expected lengths of stay (ELOS) (6.1 vs 6.4 days, P < .001). Bedspaced patients had a lower percentage of ELOS (% ELOS) than nonbedspaced patients (70% vs 91%, P < .001), similar readmission rates (9.8 vs 10.3 events per 100 patients, P = .24), lower in-hospital mortality rates (2.6 vs 3.3 events per 100 patients, P = .003) and fewer adverse events (0.20 vs 0.60 events per 100 patient days, P < .01).Bedspacing of patients is common. Patients who are bedspaced to off-service wards have better outcomes. This may relate to preferential allocation practices.
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Affiliation(s)
- Orly Bogler
- Department of Medicine, University of Toronto
| | - Jessica Liu
- Department of Medicine, University of Toronto
- Toronto General Hospital, Division of Internal Medicine, Sinai Health Systems and University Health Network, Toronto
| | - Ben Cadesky
- Department of Medicine, Lakeridge Health, Oshawa
- Department of Medicine, Queen's University, Kingston, Ontario
| | - Chaim M. Bell
- Toronto General Hospital, Division of Internal Medicine, Sinai Health Systems and University Health Network, Toronto
- Institute for Clinical Evaluative Sciences
- Institute for Health Policy, Management, and Evaluation, University of Toronto
- Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
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16
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Boncea EE, Expert P, Honeyford K, Kinderlerer A, Mitchell C, Cooke GS, Mercuri L, Costelloe CE. Association between intrahospital transfer and hospital-acquired infection in the elderly: a retrospective case-control study in a UK hospital network. BMJ Qual Saf 2021; 30:457-466. [PMID: 33495288 PMCID: PMC8142451 DOI: 10.1136/bmjqs-2020-012124] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/19/2020] [Accepted: 12/23/2020] [Indexed: 11/11/2022]
Abstract
Background Intrahospital transfers have become more common as hospital staff balance patient needs with bed availability. However, this may leave patients more vulnerable to potential pathogen transmission routes via increased exposure to contaminated surfaces and contacts with individuals. Objective This study aimed to quantify the association between the number of intrahospital transfers undergone during a hospital spell and the development of a hospital-acquired infection (HAI). Methods A retrospective case–control study was conducted using data extracted from electronic health records and microbiology cultures of non-elective, medical admissions to a large urban hospital network which consists of three hospital sites between 2015 and 2018 (n=24 240). As elderly patients comprise a large proportion of hospital users and are a high-risk population for HAIs, the analysis focused on those aged 65 years or over. Logistic regression was conducted to obtain the OR for developing an HAI as a function of intrahospital transfers until onset of HAI for cases, or hospital discharge for controls, while controlling for age, gender, time at risk, Elixhauser comorbidities, hospital site of admission, specialty of the dominant healthcare professional providing care, intensive care admission, total number of procedures and discharge destination. Results Of the 24 240 spells, 2877 cases were included in the analysis. 72.2% of spells contained at least one intrahospital transfer. On multivariable analysis, each additional intrahospital transfer increased the odds of acquiring an HAI by 9% (OR=1.09; 95% CI 1.05 to 1.13). Conclusion Intrahospital transfers are associated with increased odds of developing an HAI. Strategies for minimising intrahospital transfers should be considered, and further research is needed to identify unnecessary transfers. Their reduction may diminish spread of contagious pathogens in the hospital environment.
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Affiliation(s)
- Emanuela Estera Boncea
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Paul Expert
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK.,Department of Mathematics, Imperial College London, London, UK.,Tokyo Tech World Research Hub Initiative, Tokyo Institute of Technology, Tokyo, Japan
| | - Kate Honeyford
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Anne Kinderlerer
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Colin Mitchell
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Graham S Cooke
- Infectious Diseases Section, Imperial College London, London, UK
| | - Luca Mercuri
- Information Communications and Technology Department, Imperial College Healthcare NHS Trust, London, UK
| | - Céire E Costelloe
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
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17
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Cheung J, West S, Boughton M. The Frontline Nurse's Experience of Nursing Outlier Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145232. [PMID: 32698431 PMCID: PMC7400079 DOI: 10.3390/ijerph17145232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022]
Abstract
The frontline nurses' experience of nursing with overstretched resources in acute care setting can affect their health and well-being. Little is known about the experience of registered nurses faced with the care of a patient outside their area of expertise. The aim of this paper is to explore the phenomenon of nursing the outlier patient, when patients are nursed in a ward that is not specifically developed to deal with the major clinical diagnosis involved (e.g., renal patient in gynecology ward). Using a hermeneutic phenomenological approach, eleven individual face-to-face in-depth interviews were conducted with registered nurses in New South Wales, Australia. The study identified that each nurse had a specialty construct developed from nursing in a specialized environment. Each nurse had normalized the experience of specialty nursing and had developed a way of thinking and practicing theorized as a "care ladder". By grouping and analyzing various "care ladders" together, the nursing capacities common to nurses formed the phenomenological orientation, namely "the composite care ladder". Compared to nursing specialty-appropriate patients, nursing the outlier patient caused disruption of the care ladder, with some nurses becoming less capable as they were nursing the outlier patient. Nursing the outlier patient disrupted the nurses' normalized constructs of nursing. This study suggests that nursing patients in specialty-appropriate wards will improve patient outcomes and reduce impacts on the nurses' morale.
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Affiliation(s)
- Jasmine Cheung
- School of Nursing, Tung Wah College, Hong Kong, China
- Correspondence: ; Tel.: +852-3468-6824
| | - Sandra West
- Susan Wakil School of Nursing and Midwifery, University of Sydney, NSW 2006, Australia; (S.W.); (M.B.)
| | - Maureen Boughton
- Susan Wakil School of Nursing and Midwifery, University of Sydney, NSW 2006, Australia; (S.W.); (M.B.)
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18
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Kohn R, Harhay MO, Bayes B, Song H, Halpern SD, Kerlin MP, Greysen SR. Influence of bedspacing on outcomes of hospitalised medicine service patients: a retrospective cohort study. BMJ Qual Saf 2020; 30:116-122. [PMID: 32299956 DOI: 10.1136/bmjqs-2019-010675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/24/2020] [Accepted: 03/01/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Specialty 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. METHODS We 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. RESULTS Among 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. CONCLUSION Bedspacing 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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Affiliation(s)
- Rachel Kohn
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA .,Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadephia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael O Harhay
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadephia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian Bayes
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadephia, Pennsylvania, USA
| | - Hummy Song
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scott D Halpern
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadephia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meeta Prasad Kerlin
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadephia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - S Ryan Greysen
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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