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Mortality of hospitalised internal medicine patients bedspaced to non-internal medicine inpatient units: retrospective cohort study
  1. Anthony D Bai1,
  2. Siddhartha Srivastava1,
  3. George A Tomlinson2,
  4. Christopher A Smith1,
  5. Chaim M Bell3,
  6. Sudeep S Gill1
  1. 1Department of Medicine, Queen’s University, Kingston, ON, Canada
  2. 2Department of Medicine, University of Toronto, Toronto, ON, Canada
  3. 3Department of Medicine, Sinai Health System and University of Toronto, Toronto, ON, Canada
  1. Correspondence to Dr Sudeep S Gill, Department of Medicine, Queen’s University, 752 King St. West Kingston ON Canada K7L 4X3; ssg{at}queensu.ca

Abstract

Objective To compare inhospital mortality of general internal medicine (GIM) patients bedspaced to off-service wards with GIM inpatients admitted to assigned GIM wards.

Method A retrospective cohort study of consecutive GIM admissions between 1 January 2015 and 1 January 2016 was conducted at a large tertiary care hospital in Canada.

Inhospital mortality was compared between patients admitted to off-service wards (bedspaced) and assigned GIM wards using a Cox proportional hazards model and a competing risk model. Sensitivity analyses included propensity score and pair matching based on GIM service team, workload, demographics, time of admission, reasons for admission and comorbidities.

Results Among 3243 consecutive GIM admissions, more than a third (1125, 35%) were bedspaced to off-service wards with the rest (2118, 65%) admitted to assigned GIM wards. In hospital, 176 (5%) patients died: 88/1125 (8%) bedspaced patients and 88/2118 (4%) assigned GIM ward patients. Compared with assigned GIM wards patients, bedspaced patients had an HR of 3.42 (95% CI 2.23 to 5.26; P<0.0001) for inhospital mortality at admission, which then decreased by HR of 0.97 (95% CI 0.94 to 0.99; P=0.0133) per day in hospital. Competing risk models and sensitivity analyses using propensity scores and pair matching yielded similar results.

Conclusions Bedspaced patients had significantly higher inhospital mortality than patients admitted to assigned GIM wards. The risk was highest at admission and subsequently declined. The results of this single centre study may not be generalisable to other hospitals and may be influenced by residual confounding. Despite these limitations, the relationship between bedspacing and patient outcomes requires investigation at other institutions to determine if this common practice represents a modifiable patient safety indicator.

  • General internal medicine
  • mortality
  • bedspaced
  • bed map
  • patient flow
  • ward assignment

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Footnotes

  • Handling editor Kaveh G Shojania

  • Contributors ADB and SSG designed the study. ADB acquired the data. ADB and GAT performed the analyses. All authors were involved in interpretation of data. ADB wrote the first draft of the manuscript. All authors were involved in revisions and approving the final manuscript for publication. ADB is guarantor for the manuscript.

  • Competing interests None declared.

  • Ethics approval Ethical approval was obtained from the institution’s research ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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