Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
J Hosp Med. 2022 Jan;17(1):3-10. doi: 10.1002/jhm.2734. Epub 2022 Jan 18.
Admitting hospitalized patients to off-service wards ("bedspacing") is common and may affect quality of care and patient outcomes.
To compare in-hospital mortality, 30-day readmission to general internal medicine (GIM), and hospital length-of-stay among GIM patients admitted to GIM wards or bedspaced to off-service wards.
DESIGN, PARTICIPANTS, AND MEASURES: Retrospective cohort study including all emergency department admissions to GIM between 2015 and 2017 at six hospitals in Ontario, Canada. We compared patients admitted to GIM wards with those who were bedspaced, using multivariable regression models and propensity score matching to control for patient and situational factors.
Among 40,440 GIM admissions, 10,745 (26.6%) were bedspaced to non-GIM wards and 29,695 (73.4%) were assigned to GIM wards. After multivariable adjustment, bedspacing was associated with no significant difference in mortality (adjusted hazard ratio 0.95, 95% confidence interval [CI]: 0.86-1.05, p = .304), slightly shorter median hospital length-of-stay (-0.10 days, 95% CI:-0.20 to -0.001, p = .047) and lower 30-day readmission to GIM (adjusted OR 0.89, 95% CI: 0.83-0.95, p = .001). Results were consistent when examining each hospital individually and outcomes did not significantly differ between medical or surgical off-service wards. Sensitivity analyses focused on the highest risk patients did not exclude the possibility of harm associated with bedspacing, although adverse outcomes were not significantly greater.
Overall, bedspacing was associated with no significant difference in mortality, slightly shorter hospital length-of-stay, and fewer 30-day readmissions to GIM, although potential harms in high-risk patients remain uncertain. Given that hospital capacity issues are likely to persist, future research should aim to understand how bedspacing can be achieved safely at all hospitals, perhaps by strengthening the selection of low-risk patients.
将住院患者安排到非本科病房（“床位共享”）是很常见的做法，这可能会影响医疗质量和患者的预后。
比较内科（GIM）患者入住 GIM 病房或安排到其他非本科病房的院内死亡率、30 天内再入住 GIM 病房的比例和住院时间。
设计、参与者和措施：本研究是在加拿大安大略省的六家医院进行的一项回顾性队列研究，纳入了 2015 年至 2017 年期间所有在急诊科就诊的 GIM 患者。我们比较了入住 GIM 病房的患者和安排到非本科病房的患者，使用多变量回归模型和倾向评分匹配来控制患者和情况因素。
在 40440 例 GIM 入院患者中，10745 例（26.6%）被安排到非 GIM 病房，29695 例（73.4%）被分配到 GIM 病房。经过多变量调整后，床位共享与死亡率无显著差异（调整后的危险比 0.95，95%置信区间[CI]：0.86-1.05，p=0.304），中位住院时间略短（-0.10 天，95%CI：-0.20 至-0.001，p=0.047），30 天内再入住 GIM 的比例较低（调整后的 OR 0.89，95%CI：0.83-0.95，p=0.001）。对每家医院分别进行检查，结果一致，且医疗或外科非本科病房的结局无显著差异。对高风险患者的敏感性分析并未排除与床位共享相关的潜在危害，但不良结局并未显著增加。
总体而言，床位共享与死亡率无显著差异，住院时间略短，30 天内再入住 GIM 的比例较低，但高危患者的潜在危害仍不确定。鉴于医院容量问题可能持续存在，未来的研究应旨在了解如何在所有医院安全地实现床位共享，也许可以通过加强对低风险患者的选择来实现。
