title: Relationship between in-hospital location and outcomes of care in patients of a large general medical service.
abstract: BACKGROUND
  The discrepancy between the number of admissions and the allocation of hospital beds means that many patients admitted under the care of a general medical service can be placed in other departments' wards. These patients are called 'outliers', and their outcomes are unknown.
  
  
  OBJECTIVE
  To examine the relation between the proportion of time each patient spent in their 'home ward' during an index admission and the outcomes of that hospital stay.
  
  
  METHODS
  Data from Flinders Medical Centre's patient journey database were extracted and analysed. The analysis was carried out on the patient journeys of patients admitted under the general medicine units.
  
  
  RESULTS
  Outlier patients' length of stay was significantly shorter than that of the inlier patients (110.7 h cf 141.9 h; P < 0.001).They had a reduced risk of readmission within 28 days of discharge from hospital. Outlier patients' discharge summaries were less likely to be completed within a week (64.3% cf 78.0%; P < 0.001). Being an outlier patient increased the risk-adjusted risk of in-hospital mortality by over 40%. Fifty per cent of deaths in the outlier group occurred within 48 h of admission. Outlier patients had spent longer in the emergency department waiting for a bed (6.3 h cf 5.3 h; P < 0.001) but duration of emergency department stay was not an independent predictor of mortality risk.
  
  
  CONCLUSIONS
  Outlier patients had significantly shorter length of stay in hospital but significantly greater in-patient death rates. Surviving outlier patients had lower rates of readmission but lower rates of discharge summary completion.
authors.affiliation: School of Computer Science, Engineering and Mathematics, Information, Science and Technology, Flinders University, Australia. lua.perimal-lewis@flinders.edu.au
authors.forename: L
authors.initials: L
authors.lastname: Perimal-Lewis
authors.forename: J Y
authors.initials: JY
authors.lastname: Li
authors.forename: P H
authors.initials: PH
authors.lastname: Hakendorf
authors.forename: D I
authors.initials: DI
authors.lastname: Ben-Tovim
authors.forename: S
authors.initials: S
authors.lastname: Qin
authors.forename: C H
authors.initials: CH
authors.lastname: Thompson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D058006:General Practice / Q000379:methods / Q000639:trends*; D006748:Hospital Departments / Q000379:methods / Q000639:trends*; D017052:Hospital Mortality / Q000639:trends; D006769:Hospitals, General / Q000379:methods / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000639:trends*; D012189:Retrospective Studies; D016896:Treatment Outcome