Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadephia, Pennsylvania, USA.
BMJ Qual Saf. 2021 Feb;30(2):116-122. doi: 10.1136/bmjqs-2019-010675. Epub 2020 Apr 16.
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.
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.
Among 18 802 patients in 33 wards, 6119 (33%) patients were bedspaced. Bedspaced patients had significantly longer LOS compared with cohorted patients at the 25 (0.1 days, 95% CI: 0.05 to 0.2, p=0.001), 50 (0.2 days, 95% CI: 0.1 to 0.3, p=0.003) and 75 (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.
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.
专科病房将患者集中治疗以改善治疗效果并降低成本。当需求超过容量时，患者会溢出并被“安置”到其他病房。一些研究表明，内科服务患者之间的床位安置与不良的以患者为中心的治疗结果有关，然而，结果并不一致，并且主要是在国家卫生系统内进行的。本研究的目的是评估在美国内科、家庭医学和老年科服务患者中，床位安置与以患者为中心的治疗结果之间的关联。
我们对 2014 年和 2015 年在三家大型城市美国医院（四级转诊中心、三级转诊中心和社区医院）的 33 个病房中接受内科、家庭医学和老年科服务的患者进行了回顾性队列研究，这些患者在整个住院期间被安置在床位或集中治疗。我们进行了分位数回归，以确定床位安置与集中治疗患者的住院时间（LOS）之间的差异，并进行了逻辑回归以确定院内死亡率和出院回家的情况。
在 33 个病房的 18802 名患者中，6119 名（33%）患者被安置在床位上。与集中治疗的患者相比，床位安置的患者 LOS 明显更长，在第 25（0.1 天，95%CI：0.05 至 0.2，p=0.001）、第 50（0.2 天，95%CI：0.1 至 0.3，p=0.003）和第 75（0.3 天，95%CI：0.2 至 0.5，p<0.001）百分位数；在调整后的分析中，死亡率（OR=0.9，95%CI：0.6 至 1.3，p=0.5）或出院回家（OR=0.9，95%CI：0.9 至 1.0，p=0.06）的几率没有统计学意义。
床位安置与不良的以患者为中心的治疗结果有关。未来的工作需要确认这些发现，了解导致不良结果的机制，并确定减轻这些不良影响的因素，以便为住院患者提供高价值、以患者为中心的治疗。
