患者隔离预防措施与出院后30天再入院或死亡风险：一项前瞻性队列研究。

Patient isolation precautions and 30-day risk of readmission or death after hospital discharge: a prospective cohort study.

作者信息

Lau Darren, Majumdar Sumit R, McAlister Finlay A

机构信息

Division of General Internal Medicine, 5-134C Clinical Sciences Building, University of Alberta, 11350 83 Avenue, Edmonton, Alberta, Canada T6G 2G3.

Division of General Internal Medicine, 5-134C Clinical Sciences Building, University of Alberta, 11350 83 Avenue, Edmonton, Alberta, Canada T6G 2G3; Patient Health Outcomes Research and Clinical Effectiveness Unit (PHORCE), University of Alberta, Edmonton, Alberta, Canada.

出版信息

Int J Infect Dis. 2016 Feb;43:74-76. doi: 10.1016/j.ijid.2015.12.018. Epub 2016 Jan 2.

DOI:10.1016/j.ijid.2015.12.018

PMID:26751237

Abstract

OBJECTIVES

Concerns have been raised that isolation precautions may have unintended consequences. The relationship between patient isolation and the 30-day risk of readmission or death among patients discharged from a general medicine ward was examined.

METHODS

A prospective cohort study of adult patients discharged to the community from seven general internal medicine wards in Edmonton, Alberta, Canada, from October 2013 to November 2014, was performed. Patients under contact, respiratory, or droplet precautions were considered isolated. Covariates measured at discharge included the Charlson comorbidity score, LACE index, clinical frailty, depression, anxiety, health-related quality of life, and patient satisfaction. Outcomes were measured at 30 days by telephone follow-up and provincial electronic health record query.

RESULTS

Of 495 patients (mean age 62 years, 51% female), 75 (18%) were isolated during their admission. Isolated and non-isolated patients had similar lengths of stay (6.2 vs. 6.2 days), depression, anxiety, health-related quality of life, and satisfaction scores at discharge (all p-values non-significant). At 30 days, 85 (17.2%) patients had been readmitted or had died (20.0% of isolated patients vs. 16.7% of non-isolated patients; adjusted odds ratio 1.11, 95% confidence interval 0.57-2.18).

CONCLUSIONS

In-hospital isolation does not appear to have an adverse impact on outcomes once patients are discharged from hospital.

摘要

目的

有人担心隔离预防措施可能会产生意想不到的后果。本研究探讨了普通内科病房出院患者的隔离措施与30天再入院或死亡风险之间的关系。

方法

对2013年10月至2014年11月从加拿大艾伯塔省埃德蒙顿市七个普通内科病房出院至社区的成年患者进行了一项前瞻性队列研究。采取接触、呼吸道或飞沫隔离预防措施的患者被视为处于隔离状态。出院时测量的协变量包括查尔森合并症评分、LACE指数、临床衰弱程度、抑郁、焦虑、健康相关生活质量和患者满意度。通过电话随访和省级电子健康记录查询在30天时测量结果。

结果

495例患者（平均年龄62岁，51%为女性）中，75例（18%）在住院期间处于隔离状态。隔离患者和非隔离患者的住院时间相似（6.2天对6.2天），出院时的抑郁、焦虑、健康相关生活质量和满意度评分（所有p值均无统计学意义）。30天时，85例（17.2%）患者再次入院或死亡（隔离患者为20.0%，非隔离患者为16.7%；调整后的优势比为1.11，95%置信区间为0.57 - 2.18）。