The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study.
The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study.
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DOI：
10.1038/s41598-023-41966-w
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发表时间：
2023-09-18
影响因子：
4.6
通讯作者：
中科院分区：
文献类型：
--
作者：
世界各地医院的建筑设计都以各个部门为中心，这需要病人在病房之间移动。然而，患者并不总是采取最简单的路线从入院到出院，但可以体验复杂的运动模式，特别是当床位可用性低。很少有研究探讨这些罕见的非典型轨迹的影响。采用混合方法解释性序贯研究设计，我们首先使用新冠肺炎大流行前连续三年的电子健康记录数据，这些数据来自伦敦医院网络收治的55,152名患者，使用赫芬达尔-赫希曼指数按患者类型定义病房专科。我们探讨了具有共同专业的成对病房之间的“定期转移”、没有共同专业的成对病房之间的“非典型转移”以及不同医院地点的成对病房之间的“现场转移”对住院时间、30天再入院率和死亡率的影响。其次，为了了解非典型转移背后的可能原因，我们进行了三个焦点小组和三次深入访谈，与同一医院网络内的现场护士执业者和床位管理者。我们发现12.9%的患者至少经历过一次非典型转移。每次非典型转移与住院时间的增加相关，2.84天（95% CI 2.56-3.12），而常规转移为1.92天（95% CI 1.82-2.03）。在调整混杂因素后，死亡率或30天再入院与非典型转移之间没有关联。非典型转移似乎是由复杂的病人状况、医院能力不足、需要到达特定的服务和设施，以及更特殊的情况，如重大事件等罕见事件驱动的。我们的工作提供了一个重要的第一步，在确定不寻常的病人运动及其对关键病人的结果使用一个系统范围内，数据驱动的方法的影响。在医院政策和服务规划中应考虑在医院病房之间移动患者的更广泛影响以及可能的下游影响。
The architectural design of hospitals worldwide is centred around individual departments, which require the movement of patients between wards. However, patients do not always take the simplest route from admission to discharge, but can experience convoluted movement patterns, particularly when bed availability is low. Few studies have explored the impact of these rarer, atypical trajectories. Using a mixed-method explanatory sequential study design, we firstly used three continuous years of electronic health record data prior to the Covid-19 pandemic, from 55,152 patients admitted to a London hospital network to define the ward specialities by patient type using the Herfindahl–Hirschman index. We explored the impact of ‘regular transfers’ between pairs of wards with shared specialities, ‘atypical transfers’ between pairs of wards with no shared specialities and ‘site transfers’ between pairs of wards in different hospital site locations, on length of stay, 30-day readmission and mortality. Secondly, to understand the possible reasons behind atypical transfers we conducted three focus groups and three in-depth interviews with site nurse practitioners and bed managers within the same hospital network. We found that at least one atypical transfer was experienced by 12.9% of patients. Each atypical transfer is associated with a larger increase in length of stay, 2.84 days (95% CI 2.56–3.12), compared to regular transfers, 1.92 days (95% CI 1.82–2.03). No association was found between odds of mortality, or 30-day readmission and atypical transfers after adjusting for confounders. Atypical transfers appear to be driven by complex patient conditions, a lack of hospital capacity, the need to reach specific services and facilities, and more exceptionally, rare events such as major incidents. Our work provides an important first step in identifying unusual patient movement and its impacts on key patient outcomes using a system-wide, data-driven approach. The broader impact of moving patients between hospital wards, and possible downstream effects should be considered in hospital policy and service planning.
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影响因子：
4.1
作者：
Perimal-Lewis L;Bradley C;Hakendorf PH;Whitehead C;Heuzenroeder L;Crotty M
通讯作者：
Crotty M
影响因子：
--
作者：
Kreindler SA;Struthers A;Star N;Bowen S;Hastings S;Winters S;Johnson K;Mallinson S;Brierley M;Anwar MR;Aboud Z;Basran J;Goertzen LN
通讯作者：
Goertzen LN
影响因子：
2.7
作者：
Anwar, Mohammed Rashidul;Rowe, Brian H.;Kreindler, Sara Adi
通讯作者：
Kreindler, Sara Adi
DOI：
10.7748/nm.2021.e2016
发表时间：
2022-04-07
期刊：
Nursing management (Harrow, London, England : 1994)
影响因子：
--
作者：
Benjamin, Ellen
通讯作者：
Benjamin, Ellen
影响因子：
3.5
作者：
Caldicott, CV;Dunn, KA;Frankel, RM
通讯作者：
Frankel, RM