Evidence map›Paper›PMID 27881092›Full record

ArticleBMC geriatrics2016

The relationship between in-hospital location and outcomes of care in patients diagnosed with dementia and/or delirium diagnoses: analysis of patient journey.

Lua Perimal-Lewis, Clare Bradley, Paul H Hakendorf, Craig Whitehead, Louise Heuzenroeder, Maria Crotty

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC geriatrics, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Lua Perimal-LewisRehabilitation, Aged and Extended Care, Flinders University, GPO Box 2100, 5001, Adelaide, South Australia, Australia. lua.perimal-lewis@flinders.edu.au.ORCID http://orcid.org/0000-0001-7498-2156
Clare BradleyRehabilitation, Aged and Extended Care, Flinders University, GPO Box 2100, 5001, Adelaide, South Australia, Australia.
Paul H HakendorfFlinders Medical Centre & Flinders University, Adelaide, South Australia, Australia.
Craig WhiteheadFlinders Medical Centre & Flinders University, Adelaide, South Australia, Australia.
Louise HeuzenroederSA Health, Adelaide, South Australia, Australia.
Maria CrottyFlinders Medical Centre & Flinders University, Adelaide, South Australia, Australia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe discrepancy between the number of admissions and the allocation of hospital beds means that many patients admitted to hospital can be placed in units or wards other than that which specialise in the patient's primary health issue (home-ward). These patients are called 'outlier' patients. Risk factors and health system outcomes of hospital care for 'outlier' patients diagnosed with dementia and/or delirium are unknown. Therefore, the aim of this research was to examine patient journeys of people with dementia and/or delirium diagnoses, to identify risk factors for 'inlier' or 'outlier' status and patient or health system outcomes (consequences) of this status.

methodsA retrospective, descriptive study compared patients who had dementia and/or delirium according to the proportion of time spent on the home ward i.e. 'inliers' or 'outliers'. Data from the patient journey database at Flinders Medical Centre (FMC), a public hospital in South Australia from 2007 and 2014 were extracted and analysed. The analysis was carried out on the patient journeys of people with a dementia and/or delirium diagnosis.

resultsWhen 6367 inpatient journeys with dementia and/or delirium within FMC were examined, the Emergency Department (ED) Length of Stay (LOS) after being admitted as inpatient was prolonged for 'outlier' patients compared to 'inlier' patients (OR: 1.068, 95% CI: 1.057-1.079, p = 0.000). However, the inpatient LOS for'outlier' patients was only marginally shorter than that of the 'inlier' patients (OR: 0.998, 95% CI: 0.998-0.998, p = 0.000). The chances of dying within 48 h of admission increased for 'outlier' patients (OR: 1.973, 95% CI: 1.158-3.359, p = 0.012) and their Charlson co-morbidity Index was higher (OR: 1.059, 95% CI: 1.021-1.10, p = 0.002). Completion of discharge summaries within 2 days post-discharge for 'outlier' patients was compromised (OR: 1.754, 95% CI: 1.492-2.061, p = 0.000).Additionally, 'outlier' patients were more likely to be discharged to another hospital for other care types not offered at FMC (OR: 1.931, 95% CI: 1.559-2.391, p = 0.000).

conclusionAn examination of the patient journeys at FMC has determined that the health system outcomes for patients with dementia and/or delirium who are admitted outside of their home-ward are affected by in-hospital location despite the homogenous nature of the study population.

Indexed as

DeliriumDelivery of Health CareDementiaHealth Facility EnvironmentHospital UnitsAgedAustraliaFemaleHumansInpatientsLength of StayMaleOutcome and Process Assessment, Health CareRetrospective StudiesRisk FactorsDementia and/or deliriumHealth care deliveryOutcome and process assessment (healthcare)Patient journeyPublic hospitalsWard outliers

Identifiers

PMID27881092
PMCPMC5122028

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.