Influence of bedspacing on outcomes of hospitalised medicine service patients: a retrospective cohort study

Abstract

BackgroundSpecialty wards cohort hospitalised patients to improve outcomes and lower costs. When demand exceeds capacity, patients overflow and are “bedspaced” to alternate wards. Some studies have demonstrated that bedspacing among medicine service patients is associated with adverse patient-centred outcomes, however, results have been inconsistent and have primarily been performed within national health systems. The objective of this study was to assess the association of bedspacing with patient-centred outcomes among United States patients admitted to general medicine services.MethodsWe performed a retrospective cohort study of internal medicine, family medicine and geriatric service patients who were bedspaced vs cohorted for the entirety of their hospital stay within three large, urban United States hospitals (quaternary referral centre, tertiary referral centre and community hospital, with different patient demographics and case-mixes) in 2014 and 2015. We performed quantile regression to determine differences in length of stay (LOS) between bedspaced vs cohorted patients and logistic regression for in-hospital mortality and discharge to home.ResultsAmong 18 802 patients in 33 wards, 6119 (33%) patients were bedspaced. Bedspaced patients had significantly longer LOS compared with cohorted patients at the 25th (0.1 days, 95% CI: 0.05 to 0.2, p=0.001), 50th (0.2 days, 95% CI: 0.1 to 0.3, p=0.003) and 75th (0.3 days, 95% CI: 0.2 to 0.5, p<0.001) percentiles; and no statistically significant differences in odds of mortality (OR=0.9, 95% CI: 0.6 to 1.3, p=0.5) or discharge to home (OR=0.9, 95% CI: 0.9 to 1.0, p=0.06) in adjusted analyses.ConclusionBedspacing is associated with adverse patient-centred outcomes. Future work is needed to confirm these findings, understand mechanisms contributing to adverse outcomes and identify factors that mitigate these adverse effects in order to provide high-value, patient-centred care to hospitalised patients.

Bedspacing and clinical outcomes in general internal medicine: A retrospective, multicenter cohort study

“…There were no significant differences in mortality, length‐of‐stay, or readmission between bedspaced medical or surgical wards, after adjusting for differences in patient characteristics. Given the concerns raised in previous studies, 1,3,4,19 our results are generally reassuring, that bedspacing of GIM patients is not consistently associated with poorer clinical outcomes. However, sensitivity analyses demonstrated greater uncertainty about the safety of bedspacing in high‐risk patients, as mortality increases of up to 18%–26% were possible within the 95% CIs.…”

“…Patient care and clinical outcomes may be associated with the hospital ward to which a patient is assigned 1–4 . Hospital patients are typically cared for on cohorted wards according to their admitting diagnoses and the specialty of the physician taking care of them.…”

“…Several studies have demonstrated inconsistent effects of bedspacing on quality of care and clinical outcomes for patients 1–4 . Bedspacing has been associated with increased mortality, 1 length‐of‐stay, 3,4 and 30‐day readmission 4 in some studies whereas others have found no association with clinical outcomes 2 .…”

“…Several studies have demonstrated inconsistent effects of bedspacing on quality of care and clinical outcomes for patients 1–4 . Bedspacing has been associated with increased mortality, 1 length‐of‐stay, 3,4 and 30‐day readmission 4 in some studies whereas others have found no association with clinical outcomes 2 . Most of these studies were single‐center analyses using only administrative data and did not explore whether effects differed based on the type of bedspaced ward.…”

The Frontline Nurse’s Experience of Nursing Outlier Patients

“…One of the advantages of this co-location of patients with a similar clinical diagnosis is the development, overtime, of a body of shared knowledge and practice by the registered nurses attached to that ward. However, optimal bed utilization means that nursing the outlier patient is and will continue to be a common experience for many frontline nurses in acute care settings [ 1 , 2 , 3 ]. Nursing patients in a ward that is not addressing the specific needs of the outlier patients has implications on the nurses’ professional roles and responsibilities, consequentially affecting patients’ health outcome and nurses’ morale [ 4 , 5 ].…”