Cargando…

The Effect of Hospital Isolation Precautions on Patient Outcomes and Cost of Care: A Multi-Site, Retrospective, Propensity Score-Matched Cohort Study

BACKGROUND: Isolation precautions have negative effects on patient safety, psychological well-being, and healthcare worker contact. However, it is not known whether isolation precautions affect certain hospital-related outcomes. OBJECTIVE: To examine the effect of isolation precautions on hospital-r...

Descripción completa

Detalles Bibliográficos
Autores principales: Tran, Kim, Bell, Chaim, Stall, Nathan, Tomlinson, George, McGeer, Allison, Morris, Andrew, Gardam, Michael, Abrams, Howard B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330996/
https://www.ncbi.nlm.nih.gov/pubmed/27752880
http://dx.doi.org/10.1007/s11606-016-3862-4
_version_ 1782511293126672384
author Tran, Kim
Bell, Chaim
Stall, Nathan
Tomlinson, George
McGeer, Allison
Morris, Andrew
Gardam, Michael
Abrams, Howard B.
author_facet Tran, Kim
Bell, Chaim
Stall, Nathan
Tomlinson, George
McGeer, Allison
Morris, Andrew
Gardam, Michael
Abrams, Howard B.
author_sort Tran, Kim
collection PubMed
description BACKGROUND: Isolation precautions have negative effects on patient safety, psychological well-being, and healthcare worker contact. However, it is not known whether isolation precautions affect certain hospital-related outcomes. OBJECTIVE: To examine the effect of isolation precautions on hospital-related outcomes and cost of care. DESIGN: Retrospective, propensity-score matched cohort study of inpatients admitted to general internal medicine (GIM) services at three academic hospitals in Toronto, Ontario, Canada between January 2010 and December 2012. PARTICIPANTS: Adult (≥18 years of age) patients on isolation precautions for respiratory illnesses and methicillin-resistant Staphylococcus aureus (MRSA) were matched to controls based on propensity scores derived from nine covariates: age, sex, Resource Intensity Weight, number of hospital readmissions within 90 days, total length of stay for hospital admissions within 90 days, site of admission, month of isolation, year of isolation, and Case Mix Group. MAIN MEASURES: Thirty-day readmission rates and emergency department visits, hospital length of stay, expected length of stay, adverse events, in-hospital mortality, patient complaints, and cost of care in Canadian doll ars (CAD). KEY RESULTS: A total of 17,649 non-isolated patients were admitted to the participating hospitals during the study period. We identified 1506 patients isolated for respiratory illnesses and 745 patients isolated for MRSA. Compared to non-isolated individuals, those on isolation precautions for respiratory illnesses stayed 17 % longer (95 % CI: 9 %, 25 %), stayed 9 % longer than expected (95 % CI: 3 %, 15 %), and had 23 % higher cost of care (95 % CI: 14 %, 32 %). Patients isolated for MRSA had similar outcomes, but they also had a 4.4 % higher (95 % CI: 1.4 %, 7.3 %) rate of readmission to hospital within 30 days. CONCLUSIONS: Isolation precautions are associated with adverse effects which may result in poorer hospital outcomes. Balancing the benefits for the many with the harms to the few will be a future challenge.
format Online
Article
Text
id pubmed-5330996
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher Springer US
record_format MEDLINE/PubMed
spelling pubmed-53309962018-03-01 The Effect of Hospital Isolation Precautions on Patient Outcomes and Cost of Care: A Multi-Site, Retrospective, Propensity Score-Matched Cohort Study Tran, Kim Bell, Chaim Stall, Nathan Tomlinson, George McGeer, Allison Morris, Andrew Gardam, Michael Abrams, Howard B. J Gen Intern Med Original Research BACKGROUND: Isolation precautions have negative effects on patient safety, psychological well-being, and healthcare worker contact. However, it is not known whether isolation precautions affect certain hospital-related outcomes. OBJECTIVE: To examine the effect of isolation precautions on hospital-related outcomes and cost of care. DESIGN: Retrospective, propensity-score matched cohort study of inpatients admitted to general internal medicine (GIM) services at three academic hospitals in Toronto, Ontario, Canada between January 2010 and December 2012. PARTICIPANTS: Adult (≥18 years of age) patients on isolation precautions for respiratory illnesses and methicillin-resistant Staphylococcus aureus (MRSA) were matched to controls based on propensity scores derived from nine covariates: age, sex, Resource Intensity Weight, number of hospital readmissions within 90 days, total length of stay for hospital admissions within 90 days, site of admission, month of isolation, year of isolation, and Case Mix Group. MAIN MEASURES: Thirty-day readmission rates and emergency department visits, hospital length of stay, expected length of stay, adverse events, in-hospital mortality, patient complaints, and cost of care in Canadian doll ars (CAD). KEY RESULTS: A total of 17,649 non-isolated patients were admitted to the participating hospitals during the study period. We identified 1506 patients isolated for respiratory illnesses and 745 patients isolated for MRSA. Compared to non-isolated individuals, those on isolation precautions for respiratory illnesses stayed 17 % longer (95 % CI: 9 %, 25 %), stayed 9 % longer than expected (95 % CI: 3 %, 15 %), and had 23 % higher cost of care (95 % CI: 14 %, 32 %). Patients isolated for MRSA had similar outcomes, but they also had a 4.4 % higher (95 % CI: 1.4 %, 7.3 %) rate of readmission to hospital within 30 days. CONCLUSIONS: Isolation precautions are associated with adverse effects which may result in poorer hospital outcomes. Balancing the benefits for the many with the harms to the few will be a future challenge. Springer US 2016-10-17 2017-03 /pmc/articles/PMC5330996/ /pubmed/27752880 http://dx.doi.org/10.1007/s11606-016-3862-4 Text en © Society of General Internal Medicine 2016
spellingShingle Original Research
Tran, Kim
Bell, Chaim
Stall, Nathan
Tomlinson, George
McGeer, Allison
Morris, Andrew
Gardam, Michael
Abrams, Howard B.
The Effect of Hospital Isolation Precautions on Patient Outcomes and Cost of Care: A Multi-Site, Retrospective, Propensity Score-Matched Cohort Study
title The Effect of Hospital Isolation Precautions on Patient Outcomes and Cost of Care: A Multi-Site, Retrospective, Propensity Score-Matched Cohort Study
title_full The Effect of Hospital Isolation Precautions on Patient Outcomes and Cost of Care: A Multi-Site, Retrospective, Propensity Score-Matched Cohort Study
title_fullStr The Effect of Hospital Isolation Precautions on Patient Outcomes and Cost of Care: A Multi-Site, Retrospective, Propensity Score-Matched Cohort Study
title_full_unstemmed The Effect of Hospital Isolation Precautions on Patient Outcomes and Cost of Care: A Multi-Site, Retrospective, Propensity Score-Matched Cohort Study
title_short The Effect of Hospital Isolation Precautions on Patient Outcomes and Cost of Care: A Multi-Site, Retrospective, Propensity Score-Matched Cohort Study
title_sort effect of hospital isolation precautions on patient outcomes and cost of care: a multi-site, retrospective, propensity score-matched cohort study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330996/
https://www.ncbi.nlm.nih.gov/pubmed/27752880
http://dx.doi.org/10.1007/s11606-016-3862-4
work_keys_str_mv AT trankim theeffectofhospitalisolationprecautionsonpatientoutcomesandcostofcareamultisiteretrospectivepropensityscorematchedcohortstudy
AT bellchaim theeffectofhospitalisolationprecautionsonpatientoutcomesandcostofcareamultisiteretrospectivepropensityscorematchedcohortstudy
AT stallnathan theeffectofhospitalisolationprecautionsonpatientoutcomesandcostofcareamultisiteretrospectivepropensityscorematchedcohortstudy
AT tomlinsongeorge theeffectofhospitalisolationprecautionsonpatientoutcomesandcostofcareamultisiteretrospectivepropensityscorematchedcohortstudy
AT mcgeerallison theeffectofhospitalisolationprecautionsonpatientoutcomesandcostofcareamultisiteretrospectivepropensityscorematchedcohortstudy
AT morrisandrew theeffectofhospitalisolationprecautionsonpatientoutcomesandcostofcareamultisiteretrospectivepropensityscorematchedcohortstudy
AT gardammichael theeffectofhospitalisolationprecautionsonpatientoutcomesandcostofcareamultisiteretrospectivepropensityscorematchedcohortstudy
AT abramshowardb theeffectofhospitalisolationprecautionsonpatientoutcomesandcostofcareamultisiteretrospectivepropensityscorematchedcohortstudy
AT trankim effectofhospitalisolationprecautionsonpatientoutcomesandcostofcareamultisiteretrospectivepropensityscorematchedcohortstudy
AT bellchaim effectofhospitalisolationprecautionsonpatientoutcomesandcostofcareamultisiteretrospectivepropensityscorematchedcohortstudy
AT stallnathan effectofhospitalisolationprecautionsonpatientoutcomesandcostofcareamultisiteretrospectivepropensityscorematchedcohortstudy
AT tomlinsongeorge effectofhospitalisolationprecautionsonpatientoutcomesandcostofcareamultisiteretrospectivepropensityscorematchedcohortstudy
AT mcgeerallison effectofhospitalisolationprecautionsonpatientoutcomesandcostofcareamultisiteretrospectivepropensityscorematchedcohortstudy
AT morrisandrew effectofhospitalisolationprecautionsonpatientoutcomesandcostofcareamultisiteretrospectivepropensityscorematchedcohortstudy
AT gardammichael effectofhospitalisolationprecautionsonpatientoutcomesandcostofcareamultisiteretrospectivepropensityscorematchedcohortstudy
AT abramshowardb effectofhospitalisolationprecautionsonpatientoutcomesandcostofcareamultisiteretrospectivepropensityscorematchedcohortstudy