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The effect of time-varying capacity utilization on 14-day in-hospital mortality: a retrospective longitudinal study in Swiss general hospitals

BACKGROUND: High bed-occupancy (capacity utilization) rates are commonly thought to increase in-hospital mortality; however, little evidence supports a causal relationship between the two. This observational study aimed to assess three time-varying covariates—capacity utilization, patient turnover a...

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Autores principales: Sharma, Narayan, Moffa, Giusi, Schwendimann, René, Endrich, Olga, Ausserhofer, Dietmar, Simon, Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9764719/
https://www.ncbi.nlm.nih.gov/pubmed/36536376
http://dx.doi.org/10.1186/s12913-022-08950-y
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author Sharma, Narayan
Moffa, Giusi
Schwendimann, René
Endrich, Olga
Ausserhofer, Dietmar
Simon, Michael
author_facet Sharma, Narayan
Moffa, Giusi
Schwendimann, René
Endrich, Olga
Ausserhofer, Dietmar
Simon, Michael
author_sort Sharma, Narayan
collection PubMed
description BACKGROUND: High bed-occupancy (capacity utilization) rates are commonly thought to increase in-hospital mortality; however, little evidence supports a causal relationship between the two. This observational study aimed to assess three time-varying covariates—capacity utilization, patient turnover and clinical complexity level— and to estimate causal effect of time-varying high capacity utilization on 14 day in-hospital mortality. METHODS: This retrospective population-based analysis was based on routine administrative data (n = 1,152,506 inpatient cases) of 102 Swiss general hospitals. Considering the longitudinal nature of the problem from available literature and expert knowledge, we represented the underlying data generating mechanism as a directed acyclic graph. To adjust for patient turnover and patient clinical complexity levels as time-varying confounders, we fitted a marginal structure model (MSM) that used inverse probability of treatment weights (IPTWs) for high and low capacity utilization. We also adjusted for patient age and sex, weekdays-vs-weekend, comorbidity weight, and hospital type. RESULTS: For each participating hospital, our analyses evaluated the ≥85th percentile as a threshold for high capacity utilization for the higher risk of mortality. The mean bed-occupancy threshold was 83.1% (SD 8.6) across hospitals and ranged from 42.1 to 95.9% between hospitals. For each additional day of exposure to high capacity utilization, our MSM incorporating IPTWs showed a 2% increase in the odds of 14-day in-hospital mortality (OR 1.02, 95% CI: 1.01 to 1.03). CONCLUSIONS: Exposure to high capacity utilization increases the mortality risk of inpatients. Accurate monitoring of capacity utilization and flexible human resource planning are key strategies for hospitals to lower the exposure to high capacity utilization. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-08950-y.
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spelling pubmed-97647192022-12-21 The effect of time-varying capacity utilization on 14-day in-hospital mortality: a retrospective longitudinal study in Swiss general hospitals Sharma, Narayan Moffa, Giusi Schwendimann, René Endrich, Olga Ausserhofer, Dietmar Simon, Michael BMC Health Serv Res Research BACKGROUND: High bed-occupancy (capacity utilization) rates are commonly thought to increase in-hospital mortality; however, little evidence supports a causal relationship between the two. This observational study aimed to assess three time-varying covariates—capacity utilization, patient turnover and clinical complexity level— and to estimate causal effect of time-varying high capacity utilization on 14 day in-hospital mortality. METHODS: This retrospective population-based analysis was based on routine administrative data (n = 1,152,506 inpatient cases) of 102 Swiss general hospitals. Considering the longitudinal nature of the problem from available literature and expert knowledge, we represented the underlying data generating mechanism as a directed acyclic graph. To adjust for patient turnover and patient clinical complexity levels as time-varying confounders, we fitted a marginal structure model (MSM) that used inverse probability of treatment weights (IPTWs) for high and low capacity utilization. We also adjusted for patient age and sex, weekdays-vs-weekend, comorbidity weight, and hospital type. RESULTS: For each participating hospital, our analyses evaluated the ≥85th percentile as a threshold for high capacity utilization for the higher risk of mortality. The mean bed-occupancy threshold was 83.1% (SD 8.6) across hospitals and ranged from 42.1 to 95.9% between hospitals. For each additional day of exposure to high capacity utilization, our MSM incorporating IPTWs showed a 2% increase in the odds of 14-day in-hospital mortality (OR 1.02, 95% CI: 1.01 to 1.03). CONCLUSIONS: Exposure to high capacity utilization increases the mortality risk of inpatients. Accurate monitoring of capacity utilization and flexible human resource planning are key strategies for hospitals to lower the exposure to high capacity utilization. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-08950-y. BioMed Central 2022-12-19 /pmc/articles/PMC9764719/ /pubmed/36536376 http://dx.doi.org/10.1186/s12913-022-08950-y Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis 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/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Sharma, Narayan
Moffa, Giusi
Schwendimann, René
Endrich, Olga
Ausserhofer, Dietmar
Simon, Michael
The effect of time-varying capacity utilization on 14-day in-hospital mortality: a retrospective longitudinal study in Swiss general hospitals
title The effect of time-varying capacity utilization on 14-day in-hospital mortality: a retrospective longitudinal study in Swiss general hospitals
title_full The effect of time-varying capacity utilization on 14-day in-hospital mortality: a retrospective longitudinal study in Swiss general hospitals
title_fullStr The effect of time-varying capacity utilization on 14-day in-hospital mortality: a retrospective longitudinal study in Swiss general hospitals
title_full_unstemmed The effect of time-varying capacity utilization on 14-day in-hospital mortality: a retrospective longitudinal study in Swiss general hospitals
title_short The effect of time-varying capacity utilization on 14-day in-hospital mortality: a retrospective longitudinal study in Swiss general hospitals
title_sort effect of time-varying capacity utilization on 14-day in-hospital mortality: a retrospective longitudinal study in swiss general hospitals
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9764719/
https://www.ncbi.nlm.nih.gov/pubmed/36536376
http://dx.doi.org/10.1186/s12913-022-08950-y
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