How do busy hospital circumstances affect mortality and readmission within 60 days: A cohort study of 680 000 acute admissions in Norway |
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| Affiliation: | 1. Center for Health Care Improvement, St. Olav''s hospital, Trondheim University Hospital, Trondheim, Norway;2. Norwegian University of Science and Technology, Department of Mathematical Sciences, Trondheim, Norway;3. Norwegian University of Science and Technology, Department of Economics, Trondheim, Norway;4. Department of Health Research, SINTFF Digital, Trondheim, Norway;5. Norwegian University of Science and Technology, Department of Public Health and Nursing, Trondheim, Norway;6. Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway;7. Department of Geriatric Medicine, Clinic of Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway;8. Medical Research Council Integrative Epidemiology Unit, University of Bristol, BS8 2BN, United Kingdom;9. Population Health Sciences, Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, United Kingdom;10. Nord University, Faculty of Nursing and Health Sciences, Levanger, Norway;1. Leslie Dan Faculty of Pharmacy, University of Toronto, Canada;2. Astellas Pharma Canada, Inc, Canada;3. WHO Collaborating Centre for Governance, Transparency and Accountability in the Pharmaceutical Sector, University of Toronto, Canada;1. Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom;2. University Hospitals Birmingham NHS Foundation Trust, Level 1, Queen Elizabeth Hospital Birmingham, Mendelsohn Way, Edgbaston, Birmingham, B15 2GW, United Kingdom;3. Dee Narga, United Kingdom;1. Università degli Studi della Campania Luigi Vanvitelli, Caserta, Italia;2. Università degli Studi di Napoli Federico II, Napoli, Italia;1. Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy;2. Department of Healthcare Surveillance and Bioethics, Università Cattolica del Sacro Cuore, Rome, Italy;3. Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands;4. University of Amsterdam, Amsterdam, The Netherlands;5. Basque Foundation for Health Innovation and Research (BIOEF), Barakaldo, Spain;6. Basque Office for HTA (Osteba), Barakaldo, Spain;7. Department of Health Science, Norwegian University of Science and Technology, Gjøvik, Norway;8. Assessment of Innovations and New Technologies Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain;9. Department of Health, Medicine and Caring Sciences, National Centre for Priorities in Health, Linköping University, Linköping, Sweden;1. Université Paris Cité, LIRAES F-75006, Paris, France;2. Université Lyon 3 - Laboratoire Magellan (EA 3713), 1C avenue des Frères Lumière, Lyon 69372, France;3. LIEPP, Sciences Po, Paris, France |
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| Abstract: | ObjectiveTo study mortality and readmissions for older patients admitted during more and less busy hospital circumstances.DesignCohort study where we identified patients that were admitted to the same hospital, during the same month and day of the week. We estimated effects of inflow of acute patients and the number of concurrent acute inpatients. Mortality and readmissions were analysed using stratified Cox-regression.SettingAll people 80 years and older acutely admitted to Norwegian hospitals between 2008 and 2016.Main outcome measuresMortality and readmissions within 60 days from admission.ResultsAmong 294 653 patients with 685 197 admissions, mean age was 86 years (standard deviation 5). Overall, 13% died within 60 days. An interquartile range difference in inflow of acute patients was associated with a hazard ratio (HR) of 0.99, 95% confidence interval (95% CI) 0.98 to 1.00). There was little evidence of differences in readmissions, but a 7% higher risk (HR 1.07, 95% CI 1.06 to 1.09) of being discharged outside ordinary daytime working hours.ConclusionsOlder patients admitted during busier circumstances had similar mortality and readmissions to those admitted during less busy periods. Yet, they showed a higher risk of discharge outside daytime working hours. Despite limited effects of busyness on a hospital level, there could still be harmful effects of local situations. |
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