Frailty and adverse outcomes: impact of multiple bed moves for older inpatients

Ranasinghe, Champa; Fleury, Aisling; Peel, Nancye M.; Hubbard, Ruth E.

doi:10.1017/s1041610216001605

Cited by 8 publications

(10 citation statements)

References 21 publications

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“…These patients may be moved around the hospital several times until they reach their “home ward”. Of patients under an Older Person Evaluation Review and Assessment team, who were more likely to be boarding than general medicine patients, those with pre‐existing CI were more likely to be moved 3 or times during their hospital admission (Table ) . In a further study, boarding patients with dementia and/or delirium had higher mortality within 48 hours of admission .…”

Section: Resultsmentioning

confidence: 99%

“…Of patients under an Older Person Evaluation Review and Assessment team, who were more likely to be boarding than general medicine patients, those with pre-existing CI were more likely to be moved 3 or times during their hospital admission ( Table 2). 60 In a further study, boarding patients with dementia and/or delirium had higher mortality within 48 hours of admission. 61 Although hospital organisational factors result in night-time bed moves, these were deemed avoidable by 50% of staff surveyed in an audit, and considered detrimental to patient experience.…”

Section: "Outlying" and Bed Movesmentioning

confidence: 85%

See 1 more Smart Citation

Hospital outcomes of older people with cognitive impairment: An integrative review

Fogg

Griffiths

Meredith

et al. 2018

Int J Geriat Psychiatry

161

137

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ObjectivesTo summarise existing knowledge of outcomes of older hospital patients with cognitive impairment, including the type and frequency of outcomes reported, and the additional risk experienced by this patient group.MethodsIntegrative literature review. Health care literature databases, reports, and policy documents on key websites were systematically searched. Papers describing the outcomes of older people with cognitive impairment during hospitalisation and at discharge were analysed and summarised using integrative methods.ResultsOne hundred four articles were included. A range of outcomes were identified, including those occurring during hospitalisation and at discharge. Older people with a dementia diagnosis were at higher risk from death in hospital, nursing home admission, long lengths of stay, as well as intermediate outcomes such as delirium, falls, dehydration, reduction in nutritional status, decline in physical and cognitive function, and new infections in hospital. Fewer studies examined the relationship of all‐cause cognitive impairment with outcomes. Patient and carer experiences of hospital admission were often poor. Few studies collected data relating to hospital environment, eg, ward type or staffing levels, and acuity of illness was rarely described.ConclusionsOlder people with cognitive impairment have a higher risk of a variety of negative outcomes in hospital. Prevalent intermediate outcomes suggest that changes in care processes are required to ensure maintenance of fundamental care provision and greater attention to patient safety in this vulnerable group. More research is required to understand the most appropriate ways of doing this and how changes in these care processes are best implemented to improve hospital outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: "Outlying" and Bed Movesmentioning

confidence: 85%

Hospital outcomes of older people with cognitive impairment: An integrative review

Fogg

Griffiths

Meredith

et al. 2018

Int J Geriat Psychiatry

161

137

View full text Add to dashboard Cite

show abstract

“…10,11 For the purposes of this paper, the definition of bed moves used by Ranasinghe et al was used -"all bed changes throughout a patient's admission, including changes between or within a given ward". 12 Patients may be moved from their initial ward location for numerous reasons, including the need to accommodate another patient, transfer to "home ward", transfer to another specialist team, patient infection, transfer to intensive care, patient behaviours, need for closer observation, changing care needs of acutely ill, clinically deteriorating patient, and patient requiring palliative care. 13,14 Increased numbers of bed moves have been reported to be associated with increased patient confusion; increased length of hospitalisation; and increased adverse clinical outcomes such as falls, medication error, or pressure ulcers.…”

Section: Introductionmentioning

confidence: 99%

“…13 Patients with greater number of bed moves have been shown to have greater levels of cognitive impairment, delirium, and frailty. 12,15 System or organisational factors other than bed moves that may also impact on individual patient care and safety include the person-centredness of care, 16 level of inter-professional collaboration, 17 and the safety of the ward environment. [18][19][20][21] While there has been growing research in recent years evaluating bed moves, ward safety, and nature of care (including person-centredness), these have rarely been investigated in the one study, despite their potential interaction.…”

Section: Introductionmentioning

confidence: 99%

<p>Bed Moves, Ward Environment, Staff Perspectives and Falls for Older People with High Falls Risk in an Acute Hospital: A Mixed Methods Study</p>

Toye¹,

Slatyer²,

Kitchen³

et al. 2019

CIA

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Background: Falls remain an important problem for older people in hospital, particularly those with high falls risk. This mixed methods study investigated the association between multiple bed moves and falls during hospitalisation of older patients identified as a fall risk, as well as safety of ward environments, and staff person-centredness and level of interprofessional collaboration. Methods: Patients aged ≥70 years, admitted through the Emergency Department (ED) and identified at high fall risk, who were admitted to four target medical wards, were followed until discharge or transfer to a non-study ward. Hospital administrative data (falls, length of stay [LoS], and bed moves) were collected. Ward environmental safety audits were conducted on the four wards, and staff completed person-centredness of care, and interprofessional collaboration surveys. Staff focus groups and patient interviews provided additional qualitative data about bed moves. Results: From 486 ED tracked admissions, 397 patient records were included in comparisons between those who fell and those who did not [27 fallers/370 non-fallers (mean 84.8 years, SD 7.2; 57.4% female)]. During hospitalisation, patients experienced one to eight bed moves (mean 2.0, SD 1.2). After adjusting for LoS, the number of bed moves after the move to the initial admitting ward was significantly associated with experiencing a fall (OR 1.56, 95% CI 1.11-2.18). Ward environments had relatively few falls hazards identified, and staff surveys indicated components of person-centredness of care and interprofessional collaboration were rated as good overall, and comparable to other reported hospital data. Staff focus groups identified poor communication between discharging and admitting wards, and staff time pressures around bed moves as factors potentially increasing falls risk for involved patients. Patients reported bed moves increased their stress during an already challenging time. Conclusion: Patients who are at high risk for falls admitted to hospital have an increased risk of falling associated with every additional bed move. Strategies are needed to minimise bed moves for patients who are at high risk for falls.

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“…1 Frailty has acquired an increasing importance as an integral concept that can predict major risks of adverse events, such as functional decline, falls, hospitalization, institutionalization and mortality, negatively affecting the quality of life. 2 In that regard, Fried defined frailty by considering five physical elements, including loss of weight, self-reported exhaustion, low physical activity, walking slowly and weakness (low pressing forces). 3 Among the studies that have been carried out to elucidate the biological components associated with frailty, those that have been carried out on telomere shortening stand out.…”

Section: Introductionmentioning

confidence: 99%

Telomere shortening and frailty in Mexican older adults

Ortiz-Ramírez

Sánchez-García

Torre

et al. 2018

Geriatrics Gerontology Int

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Frailty and adverse outcomes: impact of multiple bed moves for older inpatients

Abstract: Compared with age- and sex-matched General Medicine patients, OPERA patients were more likely to undergo multiple bed moves and out-lying, which may have contributed to negative outcomes for these patients.

Cited by 8 publications

References 21 publications

Hospital outcomes of older people with cognitive impairment: An integrative review

Hospital outcomes of older people with cognitive impairment: An integrative review

<p>Bed Moves, Ward Environment, Staff Perspectives and Falls for Older People with High Falls Risk in an Acute Hospital: A Mixed Methods Study</p>

Telomere shortening and frailty in Mexican older adults

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