Demand, selection and patient outcomes in German acute care hospitals

Abstract

Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. The working papers published in the Series constitute work in progress circulated to stimulate discussion and critical comments. Views expressed represent exclusively the authors' own opinions and do not necessarily reflect those of the editors. In times of peak demand hospitals may fail to deliver the high standard of treatment quality that they are able to offer their patients at regular times. To assess the magnitude of these effects, this study analyzes the effects of low staff-to-patients ratios on patient outcomes empirically. We use the variation of patient admissions over time as a proxy for varying staff level. Further, we control for within diagnosis unobservable variation in severity across days with as opposed to days without excess demand. We find that when this variation is ignored in the regression framework, the effect of demand on outcomes is biased upwards. The reason is that when demand is high more patients with a higher unobservable frailty are admitted to the hospitals. After having controlled for this selection of patients, excess demand does not negatively affect patient outcomes. JEL Classification: I12; I18 Terms of use: Documents in

The Association Between Hospital Capacity Strain and Inpatient Outcomes in Highly Developed Countries: A Systematic Review

“…53,54 Thirty studies analyzed the association between capacity strain and mortality. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][32][33][34][35][36][37][38][39][40][41][42][43]48,49,53 All observational studies were cohort studies; all but four were retrospective. 32,42,43,46 Eight studies described interventions to improve care during times of capacity strain, [55][56][57][58][59][60][61][62] none using randomization to assign treatment category.…”

“…Most studies examined hospital mortality as the outcome of interest, while others used ICU 14,22,40 or timespecific mortality. [34][35][36]42,53 There was a statistically significant increase in mortality during times of capacity strain in 18 of 30 studies and in 9 of 12 studies in ICU settings (Table 1). While two studies reported over five-fold mortality associated with capacity strain, 13,43 several studies found more modest 50-150% increases in mortality.…”

“…31,45 Of two studies including children, one described an almost doubling in patient-related adverse events during times of high pediatric ICU occupancy, 45 while one found no significant association between neonatal ICU occupancy immediately before admission and development of nosocomial bacteremia. 32 Of 15 studies examining the relationship between capacity strain and hospital, ICU, or postoperative length of stay (LOS), 10 reported a significant association between strain and increased LOS 16,20,21,23,26,27,34,42,49,54 ; both pediatric studies reported an association between strain and increased LOS. 23,26 The magnitude of increase in LOS ranged from 1 h 23 to more than 1 day 27 ; the greatest increases in LOS were reported in studies that examined strain during mass casualty incidents.…”

“…27,49 The previously described study that measured capacity strain at ICU discharge reported that patients discharged from the ICU on days with high ICU census, acuity, and admissions had shorter ICU and post-ICU LOS. 15 Seventeen studies examined the relationship between capacity strain and additional outcomes, such as ICU or hospital readmission, 12,15,19,23,26,28,29,34,42 representation to the ED, 52 ICU admission, 21,46 delayed testing or treatment, 30,54 low Apgar scores, 46 and composite measures including morbidity and mortality. 32,50,51 All but six of these studies reported significant associations between capacity strain and outcomes.…”

Effect of a Mass Casualty Incident: Clinical Outcomes and Hospital Charges for Casualty Patients Versus Concurrent Inpatients

“…None of the aforementioned studies in the United States explicitly examined surge circumstances related to an MCI or disaster. A separate study of patient outcomes in German acute care hospitals during an “unexpected” surge in demand for resources (not in the context of an MCI) found longer hospital LOS, but no effect on emergency readmission or mortality for inpatients during the period of excess demand 17 …”