Key result
Bedspacing of hospitalized medicine service patients was associated with an increased length of stay (difference 0.3 days; 95% CI 0.2 to 0.5; p<0.001) compared to cohorted patients.
Why the study?
Studies linking bedspacing to adverse patient-centred outcomes have shown inconsistent results and were primarily conducted within national health systems.
Does bedspacing affect length of stay, mortality, or discharge to home in hospitalised medicine service patients?
Cohort
Yes
Does bedspacing affect length of stay, mortality, or discharge to home in hospitalised medicine service patients?
Mean Difference: 0.3 (95% CI 0.2–0.5)
p-value: p=<0.001
Bedspacing among general medicine patients is associated with increased length of stay but no significant difference in in-hospital mortality or discharge to home.
Bedspacing may extend US medicine stays; leaves open effects on mortality and needs prospective confirmation before practice change.
BACKGROUND: Specialty wards cohort hospitalised patients to improve outcomes and lower costs. When demand exceeds capacity, patients overflow and are "bedspaced" to alternate wards. Some studies have demonstrated that bedspacing among medicine service patients is associated with adverse patient-centred outcomes, however, results have been inconsistent and have primarily been performed within national health systems. The objective of this study was to assess the association of bedspacing with patient-centred outcomes among United States patients admitted to general medicine services. METHODS: We performed a retrospective cohort study of internal medicine, family medicine and geriatric service patients who were bedspaced vs cohorted for the entirety of their hospital stay within three large, urban United States hospitals (quaternary referral centre, tertiary referral centre and community hospital, with different patient demographics and case-mixes) in 2014 and 2015. We performed quantile regression to determine differences in length of stay (LOS) between bedspaced vs cohorted patients and logistic regression for in-hospital mortality and discharge to home. RESULTS: (0.3 days, 95% CI: 0.2 to 0.5, p<0.001) percentiles; and no statistically significant differences in odds of mortality (OR=0.9, 95% CI: 0.6 to 1.3, p=0.5) or discharge to home (OR=0.9, 95% CI: 0.9 to 1.0, p=0.06) in adjusted analyses. CONCLUSION: Bedspacing is associated with adverse patient-centred outcomes. Future work is needed to confirm these findings, understand mechanisms contributing to adverse outcomes and identify factors that mitigate these adverse effects in order to provide high-value, patient-centred care to hospitalised patients.
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Kohn et al. (2020) conducted a cohort in Hospitalised medicine service patients. Bedspacing vs. Cohorted was evaluated on Length of stay (LOS) (Difference 0.3 days, 95% CI 0.2 to 0.5, p=<0.001). Bedspacing of hospitalized medicine service patients was associated with an increased length of stay (difference 0.3 days; 95% CI 0.2 to 0.5; p<0.001) compared to cohorted patients.
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