Admitting medicine patients to off-service, nonmedicine units linked with increased in-hospital mortality


Background: Increased saturation of hospital capacity compromises patient outcomes. This creates additional challenges for the provision of appropriate specialized care. In some hospitals, patients are “bed-spaced,” or admitted to non–internal medicine service locations, such as a surgical ward, in order to free up space in the emergency department. Whether bed-spacing reduces quality of care or patient outcomes has not been previously studied.

Study design: Retrospective cohort study.

Setting: Large tertiary care academic hospital in Canada, during Jan. 1, 2015-Jan. 1, 2016.

Synopsis: There were 3,243 patients included in the analysis, of which 1,125 (35%) were bed-spaced to the off-service wards. The remaining 2,118 patients (65%) were admitted to the assigned internal medicine units. In the first week of hospitalization, in-hospital mortality among bed-spaced patients was approximately three times that of patients admitted to the assigned internal medicine wards. Upon admission, in-hospital mortality for the bed-spaced patients had a hazard ratio of 3.42 (95% confidence interval, 2.23-5.26; P less than .0001) with subsequent decrease by 0.97 (95% CI, 0.94-0.99; P = .0133) per day in the hospital. By the third week of hospitalization, the mortality risks had equalized. Sensitivity analyses revealed similar results.

Bottom line: This retrospective study is based on a single center; however, the observed increased mortality among the bed-spaced patients merits further investigation. Assessment of study generalizability and formulation of strategies for improving patient safety are needed.

Citation: Bai AD et al. Mortality of hospitalised internal medicine patients bed-spaced to non–internal medicine inpatient units: Retrospective cohort study. BMJ Qual Saf. 2018 Jan;27(1):11-20. doi: 10.1136/bmjqs-2017-006925.

Dr. Burklin is assistant professor of medicine in the division of hospital medicine, Emory University, Atlanta.

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