Tran Kim, Bell Chaim, Stall Nathan, Tomlinson George, McGeer Allison, Morris Andrew, Gardam Michael, Abrams Howard B
OpenLab, University Health Network, Toronto, ON, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
J Gen Intern Med. 2017 Mar;32(3):262-268. doi: 10.1007/s11606-016-3862-4. Epub 2016 Oct 17.
Isolation precautions have negative effects on patient safety, psychological well-being, and healthcare worker contact. However, it is not known whether isolation precautions affect certain hospital-related outcomes.
To examine the effect of isolation precautions on hospital-related outcomes and cost of care.
Retrospective, propensity-score matched cohort study of inpatients admitted to general internal medicine (GIM) services at three academic hospitals in Toronto, Ontario, Canada between January 2010 and December 2012.
Adult (≥18 years of age) patients on isolation precautions for respiratory illnesses and methicillin-resistant Staphylococcus aureus (MRSA) were matched to controls based on propensity scores derived from nine covariates: age, sex, Resource Intensity Weight, number of hospital readmissions within 90 days, total length of stay for hospital admissions within 90 days, site of admission, month of isolation, year of isolation, and Case Mix Group.
Thirty-day readmission rates and emergency department visits, hospital length of stay, expected length of stay, adverse events, in-hospital mortality, patient complaints, and cost of care in Canadian doll ars (CAD).
A total of 17,649 non-isolated patients were admitted to the participating hospitals during the study period. We identified 1506 patients isolated for respiratory illnesses and 745 patients isolated for MRSA. Compared to non-isolated individuals, those on isolation precautions for respiratory illnesses stayed 17 % longer (95 % CI: 9 %, 25 %), stayed 9 % longer than expected (95 % CI: 3 %, 15 %), and had 23 % higher cost of care (95 % CI: 14 %, 32 %). Patients isolated for MRSA had similar outcomes, but they also had a 4.4 % higher (95 % CI: 1.4 %, 7.3 %) rate of readmission to hospital within 30 days.
Isolation precautions are associated with adverse effects which may result in poorer hospital outcomes. Balancing the benefits for the many with the harms to the few will be a future challenge.
隔离预防措施对患者安全、心理健康以及医护人员接触有负面影响。然而，尚不清楚隔离预防措施是否会影响某些与医院相关的结果。
研究隔离预防措施对与医院相关的结果及护理成本的影响。
对2010年1月至2012年12月期间加拿大安大略省多伦多市三家学术医院普通内科（GIM）服务收治的住院患者进行回顾性、倾向评分匹配队列研究。
因呼吸道疾病和耐甲氧西林金黄色葡萄球菌（MRSA）而采取隔离预防措施的成年（≥18岁）患者，根据从九个协变量得出的倾向评分与对照组进行匹配，这九个协变量为：年龄、性别、资源强度权重、90天内医院再入院次数、90天内住院总时长、入院科室、隔离月份、隔离年份以及病例组合分类。
30天再入院率和急诊科就诊次数、住院时长、预期住院时长、不良事件、院内死亡率、患者投诉以及以加元（CAD）计算的护理成本。
在研究期间，共有17649名未采取隔离措施的患者入住参与研究的医院。我们确定了1506名因呼吸道疾病而采取隔离措施的患者和745名因MRSA而采取隔离措施的患者。与未采取隔离措施的个体相比，因呼吸道疾病采取隔离预防措施的患者住院时间长17%（95%置信区间：9%，25%），比预期住院时间长9%（95%置信区间：3%，15%），护理成本高23%（95%置信区间：14%，32%）。因MRSA而采取隔离措施的患者有类似结果，但他们在30天内再次入院的比率也高4.4%（95%置信区间：1.4%，7.3%）。
隔离预防措施会带来不良影响，可能导致更差的医院治疗结果。如何在使多数人受益的同时平衡少数人的伤害将是未来的一项挑战。
