Hospital discharge to other healthcare facilities: impact on in-hospital mortality
| Autor: | Gregory A Misbach, John M Robertson, Joseph S. Carey, Joseph P. Parker, Audrey L. Fisher |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
Patient Transfer
medicine.medical_specialty Databases Factual State Health Planning and Development Agencies media_common.quotation_subject Heart Valve Diseases Discharge home California Bias International Classification of Diseases Health care Outcome Assessment Health Care Hospital discharge Medicine Humans Hospital Mortality Coronary Artery Bypass Intensive care medicine Diagnosis-Related Groups media_common Heart Valve Prosthesis Implantation In hospital mortality business.industry Public health Convalescence Mortality rate Data Collection Reproducibility of Results Length of Stay Patient Discharge United States Cardiac surgery Data Interpretation Statistical Emergency medicine Surgery Health Services Research business Subacute Care |
| Zdroj: | Journal of the American College of Surgeons. 197(5) |
| ISSN: | 1072-7515 |
| Popis: | Background In-hospital mortality is frequently used as an outcomes measure for surgical procedures. Recently, hospitals have developed subacute care facilities to allow earlier discharge. Outcomes of patients discharged (transferred) to these units or to other similar facilities may not be captured in reports of in-hospital mortality. Study design The California Office of Statewide Health Planning and Development (OSHPD) patient discharge abstract database was examined to determine the rates of discharge to other facilities (transfer) and the number of in-hospital deaths occurring during the index hospitalization and after transfer in patients undergoing cardiac surgery procedures. Data were collected for 1997, 1998, and 1999 for coronary artery bypass grafting (CABG-only, n=82,897), CABG plus additional procedures (CABG-plus, n=11,869), and valve repair or replacement (Valve-only, n=14,872). In-hospital mortality and transfer rates (same-day discharge and readmission to another facility) were determined for all hospitals through the index hospitalization and subsequent transfers. Results Aggregated 3-year in-hospital mortality rates for the index hospitalization were 2.98% for CABG-only, 9.25% for CABG-plus, and 4.85% in Valve-only groups. Transfer rates were 12.41%, 23.16%, and 13.43%, respectively. The percentages of all in-hospital deaths occurring after transfer from the index hospital were 13.5% (385 of 2,857) in CABG-only, 13.3% (168 of 1,266) in CABG-plus, and 11.0% (89 of 811) in Valve-only patients. When corrected for these additional deaths, the actual in-hospital mortality rate was 3.45% for CABG-only, 10.67% for CABG-plus, and 5.45% for Valve-only procedures. Conclusions Transfer to another healthcare facility rather than discharge home is a common practice after cardiac surgery. A substantial percentage of in-hospital deaths occurs after discharge from the primary institution. |
| Databáze: | OpenAIRE |
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