Key result
Bedspacing to off-service wards was associated with no significant difference in in-hospital mortality compared to admission to general internal medicine wards (HR 0.95; 95% CI 0.86-1.05; p=0.304).
Why the study?
Admitting hospitalized patients to off-service wards is common and may affect quality of care and patient outcomes.
Does bedspacing to off-service wards affect in-hospital mortality, 30-day readmission, and length-of-stay in general internal medicine patients?
Cohort (n=40,440)
Yes
Does bedspacing to off-service wards affect in-hospital mortality, 30-day readmission, and length-of-stay in general internal medicine patients?
Bedspacing GIM patients to off-service wards was not associated with increased mortality or readmissions, suggesting it can be a safe strategy for managing hospital capacity, though caution is needed for high-risk patients.
Answers are grounded in this paper and cite their sources.
No mortality increase seen with bedspacing; leaves open its safety as capacity strategy pending randomized trials.
BACKGROUND: Admitting hospitalized patients to off-service wards ("bedspacing") is common and may affect quality of care and patient outcomes. OBJECTIVE: To compare in-hospital mortality, 30-day readmission to general internal medicine (GIM), and hospital length-of-stay among GIM patients admitted to GIM wards or bedspaced to off-service wards. DESIGN, PARTICIPANTS, AND MEASURES: Retrospective cohort study including all emergency department admissions to GIM between 2015 and 2017 at six hospitals in Ontario, Canada. We compared patients admitted to GIM wards with those who were bedspaced, using multivariable regression models and propensity score matching to control for patient and situational factors. KEY RESULTS: Among 40,440 GIM admissions, 10,745 (26.6%) were bedspaced to non-GIM wards and 29,695 (73.4%) were assigned to GIM wards. After multivariable adjustment, bedspacing was associated with no significant difference in mortality (adjusted hazard ratio 0.95, 95% confidence interval [CI]: 0.86-1.05, p = .304), slightly shorter median hospital length-of-stay (-0.10 days, 95% CI:-0.20 to -0.001, p = .047) and lower 30-day readmission to GIM (adjusted OR 0.89, 95% CI: 0.83-0.95, p = .001). Results were consistent when examining each hospital individually and outcomes did not significantly differ between medical or surgical off-service wards. Sensitivity analyses focused on the highest risk patients did not exclude the possibility of harm associated with bedspacing, although adverse outcomes were not significantly greater. CONCLUSIONS: Overall, bedspacing was associated with no significant difference in mortality, slightly shorter hospital length-of-stay, and fewer 30-day readmissions to GIM, although potential harms in high-risk patients remain uncertain. Given that hospital capacity issues are likely to persist, future research should aim to understand how bedspacing can be achieved safely at all hospitals, perhaps by strengthening the selection of low-risk patients.
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Zannella et al. (2022) conducted a cohort in General internal medicine admissions (n=40,440). Bedspacing to off-service wards vs. Admission to general internal medicine wards was evaluated on In-hospital mortality (HR 0.95, 95% CI 0.86-1.05, p=0.304). Bedspacing to off-service wards was associated with no significant difference in in-hospital mortality compared to admission to general internal medicine wards (HR 0.95; 95% CI 0.86-1.05; p=0.304).
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