title: The Impact of Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus (VRE) Flags on Hospital Operations.
abstract: OBJECTIVE To determine the impact of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus (MRSA/VRE) designations, or flags, on selected hospital operational outcomes. DESIGN Retrospective cohort study of inpatients admitted to the Massachusetts General Hospital during 2010-2011. METHODS Operational outcomes were time to bed arrival, acuity-unrelated within-hospital transfers, and length of stay. Covariates considered included demographic and clinical characteristics: age, gender, severity of illness on admission, admit day of week, residence prior to admission, hospitalization within the prior 30 days, clinical service, and discharge destination. RESULTS Overall, 81,288 admissions were included. After adjusting for covariates, patients with a MRSA/VRE flag at the time of admission experienced a mean delay in time to bed arrival of 1.03 hours (9.63 hours [95% CI, 9.39-9.88] vs 8.60 hours [95% CI, 8.47-8.73]). These patients had 1.19 times the odds of experiencing an acuity-unrelated within-hospital transfer [95% CI, 1.13-1.26] and a mean length of stay 1.76 days longer (7.03 days [95% CI, 6.82-7.24] vs 5.27 days [95% CI, 5.15-5.38]) than patients with no MRSA/VRE flag. CONCLUSIONS MRSA/VRE designation was associated with delays in time to bed arrival, increased likelihood of acuity-unrelated within-hospital transfers and extended length of stay. Efforts to identify patients who have cleared MRSA/VRE colonization are critically important to mitigate inefficient use of resources and to improve inpatient flow. Infect Control Hosp Epidemiol 2016;37:782-790.
authors.affiliation: 1Infection Control Unit,Massachusetts General Hospital,Boston,Massachusetts.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Shenoy
authors.affiliation: 5Department of Biostatistics,Massachusetts General Hospital,Boston,Massachusetts.
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.affiliation: 3Medical Practice Evaluation Center,Massachusetts General Hospital,Boston,Massachusetts.
authors.forename: Taige
authors.initials: T
authors.lastname: Hou
authors.affiliation: 6Clinical Care Management Unit,Massachusetts General Hospital,Boston,Massachusetts.
authors.forename: Winston
authors.initials: W
authors.lastname: Ware
authors.affiliation: 3Medical Practice Evaluation Center,Massachusetts General Hospital,Boston,Massachusetts.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Ryan
authors.affiliation: 1Infection Control Unit,Massachusetts General Hospital,Boston,Massachusetts.
authors.forename: David C
authors.initials: DC
authors.lastname: Hooper
authors.affiliation: 2Division of Infectious Diseases,Department of Medicine,Massachusetts General Hospital,Boston,Massachusetts.
authors.forename: Rochelle P
authors.initials: RP
authors.lastname: Walensky
mesh_terms: D001900:Boston / Q000453:epidemiology; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000517:prevention & control*; D065507:Vancomycin-Resistant Enterococci