title: Quality of care of hospitalized internal medicine patients bedspaced to non-internal medicine inpatient units.
abstract: BACKGROUND
  When the number of patients requiring hospital admission exceeds the number of available department-allotted beds, patients are often placed on a different specialty's inpatient ward, a practice known as "bedspacing". Whether bedspacing affects quality of patient care has not been previously studied.
  
  
  METHODS
  We reviewed consecutive general internal medicine (GIM) admissions for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and pneumonia at St. Michael's Hospital in Toronto, Canada, from 2007 to 2011 and examined whether quality of care differs between bedspaced and nonbedspaced patients. We matched each bedspaced patient with a GIM ward patient admitted on the same call shift with the same diagnosis. The primary outcome was the ratio of the actual to the estimated length of stay (ELOS). General and disease specific measures for CHF, COPD, and pneumonia (e.g. fluid restriction) were evaluated, as well as 30-day Emergency Department (ED) and hospital readmissions.
  
  
  RESULTS
  Overall, 1639 consecutive admissions were reviewed, and 39 matched pairs for CHF, COPD and pneumonia were studied. Differences in both general and disease specific care measures were not detected between groups. For many disease-specific comparisons, ordering and adherence to quality of care indicators was low in both groups.
  
  
  CONCLUSIONS
  We were unable to detect differences in quality of care between bedspaced and nonbedspaced patients. As high patient volumes and hospital overcrowding remains, bedspacing will likely continue. More research is required in order to determine if quality of care is compromised by this ongoing practice.
authors.affiliation: Department of Medicine, University Health Network, Toronto, Ontario, Canada.
authors.forename: Jessica
authors.initials: J
authors.lastname: Liu
authors.affiliation: Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Joshua
authors.initials: J
authors.lastname: Griesman
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Rosane
authors.initials: R
authors.lastname: Nisenbaum
authors.affiliation: University of Toronto, Department of Medicine, Toronto, Ontario, Canada; Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D005260:Female; D006742:Hospital Bed Capacity; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010343:Patient Admission; D010359:Patient Readmission; D011014:Pneumonia / Q000628:therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy; D011787:Quality of Health Care; D062606:Tertiary Care Centers