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Influence of bedspacing on outcomes of hospitalised medicine service patients: a retrospective cohort study
  1. Rachel Kohn1,2,3,
  2. Michael O Harhay1,2,3,4,
  3. Brian Bayes2,
  4. Hummy Song3,5,
  5. Scott D Halpern1,2,3,4,6,
  6. Meeta Prasad Kerlin1,2,3,
  7. S Ryan Greysen1,3
  1. 1Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadephia, Pennsylvania, USA
  3. 3Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  4. 4Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  5. 5Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  6. 6Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Rachel Kohn, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; rachel.kohn2{at}pennmedicine.upenn.edu

Abstract

Background Specialty 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.

Methods We 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.

Results Among 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.

Conclusion Bedspacing 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.

  • health services research
  • healthcare quality improvement
  • hospital medicine
  • management
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Footnotes

  • Presented at Preliminary results of this work were presented as abstracts at the Society of Hospital Medicine and Society of General Internal Medicine International Conferences 2019.

  • Contributors All of the authors made substantial contributions to the conception or design of the study, or the acquisition, analysis, or interpretation of data and drafting or revising the manuscript.

  • Funding This study was funded by National Institute on Aging (K23 AG045338), Agency for Healthcare Research and Quality (K12 HS026372-01) and National Heart, Lung, and Blood Institute (F32 HL139107-01, K23 HL146894-01 and R00 HL141678).

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement No data are available.

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