title: The Effect of Hospital Isolation Precautions on Patient Outcomes and Cost of Care: A Multi-Site, Retrospective, Propensity Score-Matched Cohort Study.
abstract: BACKGROUND
  Isolation precautions have negative effects on patient safety, psychological well-being, and healthcare worker contact. However, it is not known whether isolation precautions affect certain hospital-related outcomes.
  
  
  OBJECTIVE
  To examine the effect of isolation precautions on hospital-related outcomes and cost of care.
  
  
  METHODS
  Retrospective, propensity-score matched cohort study of inpatients admitted to general internal medicine (GIM) services at three academic hospitals in Toronto, Ontario, Canada between January 2010 and December 2012.
  
  
  METHODS
  Adult (≥18 years of age) patients on isolation precautions for respiratory illnesses and methicillin-resistant Staphylococcus aureus (MRSA) were matched to controls based on propensity scores derived from nine covariates: age, sex, Resource Intensity Weight, number of hospital readmissions within 90 days, total length of stay for hospital admissions within 90 days, site of admission, month of isolation, year of isolation, and Case Mix Group.
  
  
  METHODS
  Thirty-day readmission rates and emergency department visits, hospital length of stay, expected length of stay, adverse events, in-hospital mortality, patient complaints, and cost of care in Canadian doll ars (CAD).
  
  
  RESULTS
  A total of 17,649 non-isolated patients were admitted to the participating hospitals during the study period. We identified 1506 patients isolated for respiratory illnesses and 745 patients isolated for MRSA. Compared to non-isolated individuals, those on isolation precautions for respiratory illnesses stayed 17 % longer (95 % CI: 9 %, 25 %), stayed 9 % longer than expected (95 % CI: 3 %, 15 %), and had 23 % higher cost of care (95 % CI: 14 %, 32 %). Patients isolated for MRSA had similar outcomes, but they also had a 4.4 % higher (95 % CI: 1.4 %, 7.3 %) rate of readmission to hospital within 30 days.
  
  
  CONCLUSIONS
  Isolation precautions are associated with adverse effects which may result in poorer hospital outcomes. Balancing the benefits for the many with the harms to the few will be a future challenge.
authors.affiliation: OpenLab, University Health Network, Toronto, ON, Canada.
authors.forename: Kim
authors.initials: K
authors.lastname: Tran
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.|Department of Medicine, Division of General Internal Medicine, Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: Chaim
authors.initials: C
authors.lastname: Bell
authors.affiliation: Core Internal Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Stall
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.|Department of Medicine, University Health Network, Toronto, ON, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Tomlinson
authors.affiliation: Departments of Laboratory Medicine and Pathobiology, Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.|Department of Microbiology, Division of Infection Control, Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: Allison
authors.initials: A
authors.lastname: McGeer
authors.affiliation: Department of Medicine, University of Toronto, Toronto, ON, Canada.|Department of Medicine, Division of Infectious Diseases, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Morris
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada.|Infectious Diseases and Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Gardam
authors.affiliation: OpenLab, University Health Network, Toronto, ON, Canada. Howard.abrams@uhn.ca.|Department of Medicine, University of Toronto, Toronto, ON, Canada. Howard.abrams@uhn.ca.|Department of Medicine, Division of General Internal Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada. Howard.abrams@uhn.ca.|, TGH EN14-218, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. Howard.abrams@uhn.ca.
authors.forename: Howard B
authors.initials: HB
authors.lastname: Abrams
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D010356:Patient Isolation / Q000191:economics* / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D057216:Propensity Score; D012141:Respiratory Tract Infections / Q000191:economics / Q000453:epidemiology; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000191:economics / Q000453:epidemiology
keywords: Hospital Outcomes; Isolation