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.
ESC Heart Fail. 2022 Jun;9(3):1884-1890. doi: 10.1002/ehf2.13894. Epub 2022 Mar 28.
To study the consequences of crowded wards among patients with cardiovascular disease.
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).
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.
研究心血管疾病患者病房拥挤的后果。
这是一项对 2008 年至 2016 年间在任何一家挪威医院因急性心肌梗死（n=107895）、中风（n=87336）或心力衰竭（n=63576）而入院的 201801 名患者进行的队列研究。接收特定临床条件下大多数患者的病房被视为患者的家庭病房。我们比较了在同一医院和可比时间段内，家庭病房入住率不同时，同条件患者的入住情况。入住率标准化为一个单位的差异对应于给定月份入住率的四分位距。家庭病房入住率每增加一个四分位距，患者入住其他病房的可能性就会增加 7%[优势比（OR）1.07，95%置信区间（CI）1.09 至 1.11]，住院时间也会缩短（-0.10 天，95%CI-0.18 至-0.09）。心力衰竭患者入住其他病房的可能性增加 15%（OR 1.15，95%CI 1.08 至 1.23），死亡率增加[风险比（HR）1.08，95%CI 1.03 至 1.15]。我们没有发现心力衰竭患者的死亡率有明显影响（HR 0.99，95%CI 0.94 至 1.05）或中风（HR 1.00，95%CI 0.96 至 1.05）。
当家庭病房入住率较高时，心力衰竭患者入住其他病房的风险较高。这些患者可能会受到满病房的负面影响。
