Carl O Eriksson1, Ryan C Stoner2, Karen B Eden2, Craig D Newgard3, Jeanne-Marie Guise2,3,4,5. 1. Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health and Science University, 707 SW Gaines St., Portland, OR, 97239, USA. eriksson@ohsu.edu. 2. Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA. 3. Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA. 4. Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA. 5. OHSU-Portland State University School of Public Health, Portland, OR, USA.
Abstract
BACKGROUND: Increases in patient needs can strain hospital resources, which may worsen care quality and outcomes. This systematic literature review sought to understand whether hospital capacity strain is associated with worse health outcomes for hospitalized patients and to evaluate benefits and harms of health system interventions to improve care quality during times of hospital capacity strain. METHODS: Parallel searches were conducted in MEDLINE, CINAHL, the Cochrane Library, and reference lists from 1999-2015. Two reviewers assessed study eligibility. We included English-language studies describing the association between capacity strain (high census, acuity, turnover, or an indirect measure of strain such as delayed admission) and health outcomes or intermediate outcomes for children and adults hospitalized in highly developed countries. We also included studies of health system interventions to improve care during times of capacity strain. Two reviewers extracted data and assessed risk of bias using the Newcastle-Ottawa Score for observational studies and the Cochrane Collaboration Risk of Bias Assessment Tool for experimental studies. RESULTS: Of 5,702 potentially relevant studies, we included 44 observational and 8 experimental studies. There was marked heterogeneity in the metrics used to define capacity strain, hospital settings, and overall study quality. Mortality increased during times of capacity strain in 18 of 30 studies and in 9 of 12 studies in intensive care unit settings. No experimental studies were randomized, and none demonstrated an improvement in health outcomes after implementing the intervention. The pediatric literature is very limited; only six observational studies included children. There was insufficient study homogeneity to perform meta-analyses. DISCUSSION: In highly developed countries, hospital capacity strain is associated with increased mortality and worsened health outcomes. Evidence-based solutions to improve outcomes during times of capacity strain are needed.
BACKGROUND: Increases in patient needs can strain hospital resources, which may worsen care quality and outcomes. This systematic literature review sought to understand whether hospital capacity strain is associated with worse health outcomes for hospitalized patients and to evaluate benefits and harms of health system interventions to improve care quality during times of hospital capacity strain. METHODS: Parallel searches were conducted in MEDLINE, CINAHL, the Cochrane Library, and reference lists from 1999-2015. Two reviewers assessed study eligibility. We included English-language studies describing the association between capacity strain (high census, acuity, turnover, or an indirect measure of strain such as delayed admission) and health outcomes or intermediate outcomes for children and adults hospitalized in highly developed countries. We also included studies of health system interventions to improve care during times of capacity strain. Two reviewers extracted data and assessed risk of bias using the Newcastle-Ottawa Score for observational studies and the Cochrane Collaboration Risk of Bias Assessment Tool for experimental studies. RESULTS: Of 5,702 potentially relevant studies, we included 44 observational and 8 experimental studies. There was marked heterogeneity in the metrics used to define capacity strain, hospital settings, and overall study quality. Mortality increased during times of capacity strain in 18 of 30 studies and in 9 of 12 studies in intensive care unit settings. No experimental studies were randomized, and none demonstrated an improvement in health outcomes after implementing the intervention. The pediatric literature is very limited; only six observational studies included children. There was insufficient study homogeneity to perform meta-analyses. DISCUSSION: In highly developed countries, hospital capacity strain is associated with increased mortality and worsened health outcomes. Evidence-based solutions to improve outcomes during times of capacity strain are needed.
Authors: Peter C Jenkins; Caroline R Richardson; Edward C Norton; Colin R Cooke; Mousumi Banerjee; Avery B Nathens; Mark R Hemmila Journal: J Am Coll Surg Date: 2015-06-17 Impact factor: 6.113
Authors: Jason Wagner; Nicole B Gabler; Sarah J Ratcliffe; Sydney E S Brown; Brian L Strom; Scott D Halpern Journal: Ann Intern Med Date: 2013-10-01 Impact factor: 25.391
Authors: Sharon Einav; William P Schecter; Idit Matot; Jan K Horn; Moshe Hersch; Petachia Reissman; Ram M Spira Journal: Ann Surg Date: 2009-03 Impact factor: 12.969
Authors: Kusum S Mathews; Neha N Goel; Carmen Vargas-Torres; Ashley D Olson; Jing Zhou; Charles A Powell; Madhu Mazumdar; Gregory N Stock; Christopher M McDermott Journal: Lung Date: 2020-06-03 Impact factor: 2.584
Authors: Alexander T Janke; Hao Mei; Craig Rothenberg; Robert D Becher; Zhenqiu Lin; Arjun K Venkatesh Journal: J Hosp Med Date: 2021-04 Impact factor: 2.960
Authors: Valdery Moura Junior; M Brandon Westover; Feng Li; Eyal Kimchi; Maura Kennedy; Nicole M Benson; Lidia Maria Moura; John Hsu Journal: Health Serv Manage Res Date: 2021-07-11
Authors: Neha N Goel; Matthew S Durst; Carmen Vargas-Torres; Lynne D Richardson; Kusum S Mathews Journal: J Intensive Care Med Date: 2020-10-29 Impact factor: 3.510
Authors: Michael G Usher; Roshan Tourani; Gyorgy Simon; Christopher Tignanelli; Bryan Jarabek; Craig E Strauss; Stephen C Waring; Niall A M Klyn; Burke T Kealey; Rabindra Tambyraja; Deepti Pandita; Karyn D Baum Journal: JAMIA Open Date: 2021-07-08