School of Computer Science, Engineering and Mathematics, Information, Science and Technology, Flinders University, Australia.
Intern Med J. 2013 Jun;43(6):712-6. doi: 10.1111/imj.12066.
The discrepancy between the number of admissions and the allocation of hospital beds means that many patients admitted under the care of a general medical service can be placed in other departments' wards. These patients are called 'outliers', and their outcomes are unknown.
To examine the relation between the proportion of time each patient spent in their 'home ward' during an index admission and the outcomes of that hospital stay.
Data from Flinders Medical Centre's patient journey database were extracted and analysed. The analysis was carried out on the patient journeys of patients admitted under the general medicine units.
Outlier patients' length of stay was significantly shorter than that of the inlier patients (110.7 h cf 141.9 h; P < 0.001).They had a reduced risk of readmission within 28 days of discharge from hospital. Outlier patients' discharge summaries were less likely to be completed within a week (64.3% cf 78.0%; P < 0.001). Being an outlier patient increased the risk-adjusted risk of in-hospital mortality by over 40%. Fifty per cent of deaths in the outlier group occurred within 48 h of admission. Outlier patients had spent longer in the emergency department waiting for a bed (6.3 h cf 5.3 h; P < 0.001) but duration of emergency department stay was not an independent predictor of mortality risk.
Outlier patients had significantly shorter length of stay in hospital but significantly greater in-patient death rates. Surviving outlier patients had lower rates of readmission but lower rates of discharge summary completion.
住院人数与医院床位分配之间的差异意味着许多在普通医疗服务下住院的患者可以被安置在其他科室的病房。这些患者被称为“离群值”，其结果未知。
检查每位患者在指数住院期间在其“家庭病房”中度过的时间比例与该住院期间的结果之间的关系。
从弗林德斯医疗中心的患者旅程数据库中提取并分析数据。对普通医学病房收治的患者的患者旅程进行了分析。
离群值患者的住院时间明显短于内群值患者（110.7 小时比 141.9 小时；P<0.001）。他们在出院后 28 天内再次入院的风险降低。离群值患者出院小结在一周内完成的可能性较小（64.3%比 78.0%；P<0.001）。作为离群值患者，住院期间的死亡率风险增加了 40%以上。离群值组中有 50%的死亡发生在入院后 48 小时内。离群值患者在急诊部等待床位的时间更长（6.3 小时比 5.3 小时；P<0.001），但急诊部停留时间并不是死亡率风险的独立预测因素。
离群值患者的住院时间明显缩短，但住院死亡率显著增加。幸存的离群值患者再次入院率较低，但出院小结完成率较低。
