The probability of readmission within 30 days of hospital discharge is positively associated with inpatient bed occupancy at discharge - a retrospective cohort study
The probability of readmission within 30 days of hospital discharge is positively associated with inpatient bed occupancy at discharge - a retrospective cohort study
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DOI：
10.1186/s12873-015-0067-9
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发表时间：
2015-01-01
影响因子：
2.5
通讯作者：
Ivarsson, Kjell
中科院分区：
文献类型：
--
作者：
Blom, Mathias C.;Erwander, Karin;Ivarsson, Kjell
背景资料：以前的研究表明，考虑到医院需要从急诊科（艾德）接收更多的患者，高住院床位占用率可能会鼓励过早出院，这有利于医院对床位的需求，而不是患者的医疗利益。我们认为，这种行动的影响将是可衡量的，因为在出院的患者中，计划外再入院的比例更大时，医院是满的，而不是。作为回应，本研究通过调查出院时住院床位占用率与30天再入院率之间的关系来验证这一假设。方法：样本包括2011-2012年期间瑞典南部一家拥有420张床位的急诊医院的艾德所有住院患者，这些患者在2012年12月1日之前出院。30天内计划外再入院的比例计算为出院时住院床位占用率<95%、95- 100%、100- 105%和> 105%。构建二元逻辑回归模型，以调整年龄，出院时间和其他可能影响outcome.Results的因素：在所有，32,811次访问被纳入研究，其中9.9%导致在出院后30天内的计划外再入院。患者出院时入住率水平<95%的再入院比例为9.0%，95- 100%入住率为10.2%，100- 105%入住率为10.8%，> 105%入住率为10.5%（p = 0.0001）。多因素分析结果显示，再入院的OR（95%CI）为1.11（1.01-1.22）对于95- 100%入住率出院的患者，1.17（1.06-1.29），入住率为100- 105%，（0.99-1.34）在> 105%占有率。结果表明，在住院床位占用率高的情况下，从住院病房出院的患者在住院后30天内意外再入院的风险增加。放电
Background: Previous work has suggested that given a hospital's need to admit more patients from the emergency department (ED), high inpatient bed occupancy may encourage premature hospital discharges that favor the hospital's need for beds over patients' medical interests. We argue that the effects of such action would be measurable as a greater proportion of unplanned hospital readmissions among patients discharged when the hospital was full than when not. In response, the present study tested this hypothesis by investigating the association between inpatient bed occupancy at the time of hospital discharge and the 30-day readmission rate.Methods: The sample included all inpatient admissions from the ED at a 420-bed emergency hospital in southern Sweden during 2011-2012 that resulted in discharge before 1 December 2012. The share of unplanned readmissions within 30 days was computed for levels of inpatient bed occupancy of < 95 %, 95-100 %, 100-105 % and > 105 % at the hour of discharge. A binary logistic regression model was constructed to adjust for age, time of discharge, and other factors that could affect the outcome.Results: In all, 32,811 visits were included in the study, 9.9 % of which resulted in an unplanned readmission within 30 days of discharge. The proportion of readmissions was 9.0 % for occupancy levels of < 95 % at the patient's discharge, 10.2 % for 95-100 % occupancy, 10.8 % for 100-105 % occupancy, and 10.5 % for > 105 % occupancy (p = 0.0001). Results from the multivariate models show that the OR (95 % CI) of readmission was 1.11 (1.01-1.22) for patients discharged at 95-100 % occupancy, 1.17 (1.06-1.29) at 100-105 % occupancy, and 1.15 (0.99-1.34) at > 105 % occupancy.Conclusions: Results indicate that patients discharged from inpatient wards at times of high inpatient bed occupancy experience an increased risk of unplanned readmission within 30 days of discharge.