PMID- 17446831
OWN - NLM
STAT- MEDLINE
DCOM- 20070612
LR  - 20220321
IS  - 0025-7079 (Print)
IS  - 0025-7079 (Linking)
VI  - 45
IP  - 5
DP  - 2007 May
TI  - Hospital workload and adverse events.
PG  - 448-55
AB  - CONTEXT: Hospitals are under pressure to increase revenue and lower costs, and at 
      the same time, they face dramatic variation in clinical demand. OBJECTIVE: : We 
      sought to determine the relationship between peak hospital workload and rates of 
      adverse events (AEs). METHODS: A random sample of 24,676 adult patients 
      discharged from the medical/surgical services at 4 US hospitals (2 urban and 2 
      suburban teaching hospitals) from October 2000 to September 2001 were screened 
      using administrative data, leaving 6841 cases to be reviewed for the presence of 
      AEs. Daily workload for each hospital was characterized by volume, throughput 
      (admissions and discharges), intensity (aggregate DRG weight), and staffing 
      (patient-to-nurse ratios). For volume, we calculated an "enhanced" occupancy rate 
      that accounted for same-day bed occupancy by more than 1 patient. We used Poisson 
      regressions to predict the likelihood of an AE, with control for workload and 
      individual patient complexity, and the effects of clustering. RESULTS: One urban 
      teaching hospital had enhanced occupancy rates more than 100% for much of the 
      year. At that hospital, admissions and patients per nurse were significantly 
      related to the likelihood of an AE (P < 0.05); occupancy rate, discharges, and 
      DRG-weighted census were significant at P < 0.10. For example, a 0.1% increase in 
      the patient-to-nurse ratio led to a 28% increase in the AE rate. Results at the 
      other 3 hospitals varied and were mainly non significant. CONCLUSIONS: Hospitals 
      that operate at or over capacity may experience heightened rates of patient 
      safety events and might consider re-engineering the structures of care to respond 
      better during periods of high stress.
FAU - Weissman, Joel S
AU  - Weissman JS
AD  - Institute for Health Policy, Massachusetts General Hospital, Boston, 
      Massachusetts 02114, USA. jweissman@partners.org
FAU - Rothschild, Jeffrey M
AU  - Rothschild JM
FAU - Bendavid, Eran
AU  - Bendavid E
FAU - Sprivulis, Peter
AU  - Sprivulis P
FAU - Cook, E Francis
AU  - Cook EF
FAU - Evans, R Scott
AU  - Evans RS
FAU - Kaganova, Yevgenia
AU  - Kaganova Y
FAU - Bender, Melissa
AU  - Bender M
FAU - David-Kasdan, JoAnn
AU  - David-Kasdan J
FAU - Haug, Peter
AU  - Haug P
FAU - Lloyd, Jim
AU  - Lloyd J
FAU - Selbovitz, Leslie G
AU  - Selbovitz LG
FAU - Murff, Harvey J
AU  - Murff HJ
FAU - Bates, David W
AU  - Bates DW
LA  - eng
GR  - 1 R01 HS12035/HS/AHRQ HHS/United States
GR  - R01 HS12035-02-S1/HS/AHRQ HHS/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Med Care
JT  - Medical care
JID - 0230027
SB  - IM
MH  - Aged
MH  - Bed Occupancy/statistics & numerical data
MH  - Diagnosis-Related Groups
MH  - Female
MH  - Hospitals, Teaching/*standards/statistics & numerical data
MH  - Humans
MH  - Male
MH  - Medical Audit
MH  - Medical Errors/statistics & numerical data/*trends
MH  - Middle Aged
MH  - Personnel, Hospital/psychology/*statistics & numerical data
MH  - Poisson Distribution
MH  - Quality of Health Care
MH  - Safety Management
MH  - United States
MH  - Workload/*statistics & numerical data
EDAT- 2007/04/21 09:00
MHDA- 2007/06/15 09:00
CRDT- 2007/04/21 09:00
PHST- 2007/04/21 09:00 [pubmed]
PHST- 2007/06/15 09:00 [medline]
PHST- 2007/04/21 09:00 [entrez]
AID - 00005650-200705000-00011 [pii]
AID - 10.1097/01.mlr.0000257231.86368.09 [doi]
PST - ppublish
SO  - Med Care. 2007 May;45(5):448-55. doi: 10.1097/01.mlr.0000257231.86368.09.