Outlier admissions of medical patients: prognostic implications of outlying patients. The experience of the Hospital of Mestre

What Quality and Safety of Care for Patients Admitted to Clinically Inappropriate Wards: a Systematic Review

“…Perimal-Lewis et al 9 registered a significantly shorter length of stay among outliers (110.7 h vs 141.9 h). No difference was found by Serafini et al, 7 either for medicine or geriatrics (10 vs 9.8 days and 13 days for both, respectively) or by Bai et al (5.31 vs 5.97 days; p = 0.1119). 4…”

“…Serafini et al 7 investigated 3828 consecutive patients hospitalized in medicine and geriatrics in 2012 and, after adjustment for age and sex, the risk of death was about twice as high for outlier patients admitted to surgical area versus the medical one (hazard ratio 1.8, 95% CI 1.2-2.5).…”

“…ED stay was longer in patients eventually admitted to outlying wards; 6 respiratory patients were less likely to be outliers than other diseases. 7 One study 11 found that the Btime burden^from visiting patients on outlying wards was significant, nearly doubling the total time spent with patients, though most of this was due to travel time. In addition to taking more time, another study found that elective operations were reduced by almost 15% in presence of outliers boarding on the surgical wards.…”

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.…”

“…While two studies reported over five-fold mortality associated with capacity strain, 13,43 several studies found more modest 50-150% increases in mortality. 32,36,39,41,48 Only two studies included children: a multi-institution UK study that found a doubling in mortality odds for patients admitted at maximum compared to 50% occupancy 32 and a single-institution US study that found no significant association between ED boarding time and subsequent hospital mortality. 23 Study quality did not appear to affect the likelihood of reporting a positive relationship between strain and mortality.…”