Do outlier inpatients experience more emergency calls in hospital? An observational cohort study

Objective: To determine the effect of spending time as an outlier (ie, an inpatient who spends time away from his or her “home” ward) on the frequency of emergency calls for patients admitted to a tertiary referral hospital. Design, setting and patients: Observational cohort study of all patients admitted to a university-affiliated tertiary referral hospital in Melbourne, Victoria, between 1 July 2009 and 30 November 2011. Main outcome measure: The number of emergency calls per hospital admission, with reference to location within the hospital. Results: There were 58 158 admissions during the study period. The median age of admitted patients was 61 years, 55% were male, and the inhospital mortality was 1.40%. In 11 034 admissions (18.97%), patients spent time as outliers. Inhospital mortality was 2.57% in the outlier group versus 1.12% in the non-outlier group (P < 0.001). After adjusting for age, same-day admission, 10-year predicted mortality, interhospital transfer and high-risk clinical units, outlier status was associated with a 53% increase in emergency calls (P < 0.001). Conclusions: This study found a strong association between time spent away from a patient’s home ward and the number of emergency calls. We postulate that outlier patients are at risk as they may have therapeutic and monitoring needs that are only available on their home ward. With increasing pressure to move patients out of the emergency department, the number of outlier patients may increase