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The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study

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...

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Autores principales: Mendelsohn, Estera, Honeyford, Kate, Brittin, Andy, Mercuri, Luca, Klaber, Robert Edward, Expert, Paul, Costelloe, Céire
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10507077/
https://www.ncbi.nlm.nih.gov/pubmed/37723183
http://dx.doi.org/10.1038/s41598-023-41966-w
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author Mendelsohn, Estera
Honeyford, Kate
Brittin, Andy
Mercuri, Luca
Klaber, Robert Edward
Expert, Paul
Costelloe, Céire
author_facet Mendelsohn, Estera
Honeyford, Kate
Brittin, Andy
Mercuri, Luca
Klaber, Robert Edward
Expert, Paul
Costelloe, Céire
author_sort Mendelsohn, Estera
collection PubMed
description 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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spelling pubmed-105070772023-09-20 The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study Mendelsohn, Estera Honeyford, Kate Brittin, Andy Mercuri, Luca Klaber, Robert Edward Expert, Paul Costelloe, Céire Sci Rep Article 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. Nature Publishing Group UK 2023-09-18 /pmc/articles/PMC10507077/ /pubmed/37723183 http://dx.doi.org/10.1038/s41598-023-41966-w Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Mendelsohn, Estera
Honeyford, Kate
Brittin, Andy
Mercuri, Luca
Klaber, Robert Edward
Expert, Paul
Costelloe, Céire
The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study
title The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study
title_full The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study
title_fullStr The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study
title_full_unstemmed The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study
title_short The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study
title_sort impact of atypical intrahospital transfers on patient outcomes: a mixed methods study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10507077/
https://www.ncbi.nlm.nih.gov/pubmed/37723183
http://dx.doi.org/10.1038/s41598-023-41966-w
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