Associations between in-hospital bed occupancy and unplanned 72-h revisits to the emergency department: a register study.

Autor: Blom MC; Department of Clinical Science Lund, Lund University, Hs 32, EA-blocket, Plan 2, Lund 22185, Sweden., Jonsson F; Department of Emergency, Helsingborg Hospital, S Vallgatan 5, Helsingborg 25187, Sweden., Landin-Olsson M; Department of Clinical Science Lund, Lund University, Hs 32, EA-blocket, Plan 2, Lund 22185, Sweden., Ivarsson K; Department of Clinical Science Lund, Lund University, Hs 32, EA-blocket, Plan 2, Lund 22185, Sweden.
Jazyk: angličtina
Zdroj: International journal of emergency medicine [Int J Emerg Med] 2014 Jun 28; Vol. 7, pp. 25. Date of Electronic Publication: 2014 Jun 28 (Print Publication: 2014).
DOI: 10.1186/s12245-014-0025-4
Abstrakt: Background: A possible downstream effect of high in-hospital bed occupancy is that patients in the emergency department (ED) who would benefit from in-hospital care are denied admission. The present study aimed at evaluating this hypothesis through investigating associations between in-hospital bed occupancy at the time of presentation in the ED and the probability for unplanned 72-hour (72-h) revisits to the ED among patients discharged at index. A second outcome was unplanned 72-h revisits resulting in admission.
Methods: All visits to the ED of a 420-bed emergency hospital in southern Sweden between 1 January 2011 and 31 December 2012, which did not result in admission, death, or transfer to another hospital were included. Revisiting fractions were computed for in-hospital occupancy intervals <85%, 85% to 90%, 90% to 95%, 95% to 100%, 100% to 105%, and ≥105%. Multivariate models were constructed in an attempt to take confounding factors from, e.g., presenting complaints, age, referral status, and triage priority into account.
Results: Included in the study are 81,878 visits. The fraction of unplanned 72-h revisits/unplanned 72-h revisits resulting in admission was 5.8%/1.4% overall, 6.2%/1.4% for occupancy <85%, 6.4%/1.5% for occupancy 85% to 90%, 5.8%/1.4% for occupancy 90% to 95%, 6.0%/1.6% for occupancy 95% to 100%, 5.4%/1.6% for occupancy 100% to 105%, and 4.9%/1.4% for occupancy ≥105%. In the multivariate models, a trend to lower probability of unplanned 72-h revisits was observed at occupancy ≥105% compared to occupancy <95% (OR 0.88, CI 0.76 to 1.01). No significant associations between in-hospital occupancy at index and the probability of making unplanned 72-h revisits resulting in admission were observed.
Conclusions: The lack of associations between in-hospital occupancy and unplanned 72-h revisits does not support the hypothesis that ED patients are inappropriately discharged when in-hospital beds are scarce. The results are reassuring as they indicate that physicians are able to make good decisions, also while resources are constrained.
Databáze: MEDLINE
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