Dataset Information

Quality of care of hospitalized internal medicine patients bedspaced to non-internal medicine inpatient units.

ABSTRACT:

Background

When the number of patients requiring hospital admission exceeds the number of available department-allotted beds, patients are often placed on a different specialty's inpatient ward, a practice known as "bedspacing". Whether bedspacing affects quality of patient care has not been previously studied.

Methods

We reviewed consecutive general internal medicine (GIM) admissions for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and pneumonia at St. Michael's Hospital in Toronto, Canada, from 2007 to 2011 and examined whether quality of care differs between bedspaced and nonbedspaced patients. We matched each bedspaced patient with a GIM ward patient admitted on the same call shift with the same diagnosis. The primary outcome was the ratio of the actual to the estimated length of stay (ELOS). General and disease specific measures for CHF, COPD, and pneumonia (e.g. fluid restriction) were evaluated, as well as 30-day Emergency Department (ED) and hospital readmissions.

Results

Overall, 1639 consecutive admissions were reviewed, and 39 matched pairs for CHF, COPD and pneumonia were studied. Differences in both general and disease specific care measures were not detected between groups. For many disease-specific comparisons, ordering and adherence to quality of care indicators was low in both groups.

Conclusions

We were unable to detect differences in quality of care between bedspaced and nonbedspaced patients. As high patient volumes and hospital overcrowding remains, bedspacing will likely continue. More research is required in order to determine if quality of care is compromised by this ongoing practice.

SUBMITTER: Liu J

PROVIDER: S-EPMC4153721 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Publications

Quality of care of hospitalized internal medicine patients bedspaced to non-internal medicine inpatient units.

Liu Jessica J Griesman Joshua J Nisenbaum Rosane R Bell Chaim M CM

PloS one 20140903 9

<h4>Background</h4>When the number of patients requiring hospital admission exceeds the number of available department-allotted beds, patients are often placed on a different specialty's inpatient ward, a practice known as "bedspacing". Whether bedspacing affects quality of patient care has not been previously studied.<h4>Methods</h4>We reviewed consecutive general internal medicine (GIM) admissions for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and pneumonia a ...[more]

PMID: 25184480

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Project description:Severe acidosis can cause noninvasive ventilation (NIV) failure in chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure (AHRF). NIV is therefore contraindicated outside of intensive care units (ICUs) in these patients. Less is known about NIV failure in patients with acute cardiogenic pulmonary edema (ACPE) and obesity hypoventilation syndrome (OHS). Therefore, the objective of the present study was to compare NIV failure rates between patients with severe and non-severe acidosis admitted to a respiratory intermediate care unit (RICU) with AHRF resulting from ACPE, COPD or OHS.We prospectively included acidotic patients admitted to seven RICUs, where they were provided NIV as an initial ventilatory support measure. The clinical characteristics, pH evolutions, hospitalization or RICU stay durations and NIV failure rates were compared between patients with a pH???7.25 and a pH?<?7.25. Logistic regression analysis was performed to determine the independent risk factors contributing to NIV failure.We included 969 patients (240 with ACPE, 540 with COPD and 189 with OHS). The baseline rates of severe acidosis were similar among the groups (45 % in the ACPE group, 41 % in the COPD group, and 38 % in the OHS group). Most of the patients with severe acidosis had increased disease severity compared with those with non-severe acidosis: the APACHE II scores were 21?±?7.2 and 19?±?5.8 for the ACPE patients (p?<?0.05), 20?±?5.7 and 19?±?5.1 for the COPD patients (p?<?0.01) and 18?±?5.9 and 17?±?4.7 for the OHS patients, respectively (NS). The patients with severe acidosis also exhibited worse arterial blood gas parameters: the PaCO2 levels were 87?±?22 and 70?±?15 in the ACPE patients (p?<?0.001), 87?±?21 and 76?±?14 in the COPD patients, and 83?±?17 and 74?±?14 in the OHS patients (NS)., respectively Further, the patients with severe acidosis required a longer duration to achieve pH normalization than those with non-severe acidosis (patients with a normalized pH after the first hour: ACPE, 8 % vs. 43 %, p?<?0.001; COPD, 11 % vs. 43 %, p?<?0.001; and OHS, 13 % vs. 51 %, p?<?0.001), and they had longer RICU stays, particularly those in the COPD group (ACPE, 4?±?3.1 vs. 3.6?±?2.5, NS; COPD, 5.1?±?3 vs. 3.6?±?2.1, p?<?0.001; and OHS, 4.3?±?2.6 vs. 3.7?±?3.2, NS). The NIV failure rates were similar between the patients with severe and non-severe acidosis in the three disease groups (ACPE, 16 % vs. 12 %; COPD, 7 % vs. 7 %; and OHS, 11 % vs. 4 %). No common predictive factor for NIV failure was identified among the groups.ACPE, COPD and OHS patients with AHRF and severe acidosis (pH???7.25) who are admitted to an RICU can be successfully treated with NIV in these units. These results may be used to determine precise RICU admission criteria.

Project description:BACKGROUND:The precise scope of hospital care delivered under general internal medicine services remains poorly quantified. The purpose of this study was to describe the demographic characteristics, medical conditions, health outcomes and resource use of patients admitted to general internal medicine at 7 hospital sites in the Greater Toronto Area. METHODS:This was a retrospective cohort study involving all patients who were admitted to or discharged from general internal medicine at the study sites between Apr. 1, 2010, and Mar. 31, 2015. Clinical data from hospital electronic information systems were linked to administrative data from each hospital. We examined trends in resource use and patient characteristics over the study period. RESULTS:There were 136?208 admissions to general internal medicine involving 88?121 unique patients over the study period. General internal medicine admissions accounted for 38.8% of all admissions from the emergency department and 23.7% of all hospital bed-days. Over the study period, the number of admissions to general internal medicine increased by 32.4%; there was no meaningful change in the median length of stay or cost per hospital stay. The median patient age was 73 (interquartile range [IQR] 57-84) years, and the median number of coexisting conditions was 6 (IQR 3-9). The median acute length of stay was 4.6 (IQR 2.5-8.6) days, and the median total cost per hospital stay was $5850 (IQR $3915-$10?061). Patients received at least 1 computed tomography scan in 52.2% of admissions. The most common primary discharge diagnoses were pneumonia (5.0% of admissions), heart failure (4.7%), chronic obstructive pulmonary disease (4.1%), urinary tract infection (4.0%) and stroke (3.6%). INTERPRETATION:Patients admitted to general internal medicine services represent a large, heterogeneous, resource-intensive and growing population. Understanding and improving general internal medicine care is essential to promote a high-quality, sustainable health care system.

Dataset Information

Quality of care of hospitalized internal medicine patients bedspaced to non-internal medicine inpatient units.

Background

Methods

Results

Conclusions

Publications

Quality of care of hospitalized internal medicine patients bedspaced to non-internal medicine inpatient units.

Similar Datasets

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