SynthesisJournal of general internal medicine2017
The Association Between Hospital Capacity Strain and Inpatient Outcomes in Highly Developed Countries: A Systematic Review.
Synthesis in Journal of general internal medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 83 papers, 2 of them syntheses that pooled 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.
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.
Who cites it
83 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Patients and staff perspectives on hospital ward strain and its impacts on patient care and the workforce: a mixed-methods systematic review.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2026Pooled it
- Hospitalisation as an Opportunity to Optimise Quality Use of Medicines in Older Adults: A Systematic Review.Drugs & aging · 2026Pooled it
- Predictors of Respiratory Support Use in Emergency Department Patients With COVID-19-Related Respiratory Failure.Respiratory care · 2022Trial
- Unpacking the null: a post-hoc analysis of a cluster-randomised controlled trial of the WHO Safe Childbirth Checklist in Uttar Pradesh, India (BetterBirth).The Lancet. Global health · 2019Trial
- Delayed Argon Plasma Coagulation After Endoscopic Injection Sclerotherapy for Esophageal Varices Reduces Recurrence Risk.DEN open · 2027Article
- Article
- Factors associated with discharge to skilled nursing despite a clinical recommendation for inpatient rehabilitation.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2026Article
- Association of Geriatric Emergency Department Care With Hospitalization and Mortality in Older Adults.Journal of the American Geriatrics Society · 2026Article
- Can routinely collected electronic medical record (EMR) data support hospital resource allocation? A retrospective analysis of 332,711 presentations to a public quaternary teaching hospital in South Australia (2020-2025).BMC health services research · 2026Article
- Impact of COVID-19 on sputum isolates and hospital outcomes among patients with pneumonia in Sheffield, United Kingdom: a retrospective cohort study.Frontiers in public health · 2026Article
- Article
- Impact of Boarding Time on In-Hospital Mortality in Patients Presenting to an Oncologic Emergency Department of a Comprehensive Cancer Center.Journal of the American College of Emergency Physicians open · 2025Article
- How Are Pedagogical Practices Within Medical Education Being Adapted for Autistic Students?Cureus · 2025Review
- Development and internal validation of a clinical prediction model for the needed level of care in preterm neonates.BMC pediatrics · 2025Article
- Prolonged Length of Stay at Out-of-State Trauma Centers: Potential Role for Repatriation.Journal of the American College of Surgeons · 2025Article
- Pediatric Bed Capacity, Bed Strain, and Load Imbalance During the 2022 Respiratory Viral Season.JAMA network open · 2025Article
- Economic Evaluation of the Next Generation Electronic Medical Records in Singapore: Cost-Utility Analysis.Journal of medical Internet research · 2025Article
- Associations of hospital unit occupancy with inpatient falls and fall-risk assessment completion: a retrospective cohort study.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2025Article
- Atrial Fibrillation Treatment Pathway in the Emergency Department Reduces Median 30-Day Health Service Charges.Journal of the American Heart Association · 2025Article
- Simulating the effects of reducing transfer latency from the intensive care unit on intensive care unit bed utilization in a Korean Tertiary Hospital.Acute and critical care · 2025Article
23 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
backgroundIncreases in patient needs can strain hospital resources, which may worsen care quality and outcomes. This systematic literature review sought to understand whether hospital capacity strain is associated with worse health outcomes for hospitalized patients and to evaluate benefits and harms of health system interventions to improve care quality during times of hospital capacity strain.
methodsParallel searches were conducted in MEDLINE, CINAHL, the Cochrane Library, and reference lists from 1999-2015. Two reviewers assessed study eligibility. We included English-language studies describing the association between capacity strain (high census, acuity, turnover, or an indirect measure of strain such as delayed admission) and health outcomes or intermediate outcomes for children and adults hospitalized in highly developed countries. We also included studies of health system interventions to improve care during times of capacity strain. Two reviewers extracted data and assessed risk of bias using the Newcastle-Ottawa Score for observational studies and the Cochrane Collaboration Risk of Bias Assessment Tool for experimental studies.
resultsOf 5,702 potentially relevant studies, we included 44 observational and 8 experimental studies. There was marked heterogeneity in the metrics used to define capacity strain, hospital settings, and overall study quality. Mortality increased during times of capacity strain in 18 of 30 studies and in 9 of 12 studies in intensive care unit settings. No experimental studies were randomized, and none demonstrated an improvement in health outcomes after implementing the intervention. The pediatric literature is very limited; only six observational studies included children. There was insufficient study homogeneity to perform meta-analyses. DISCUSSION: In highly developed countries, hospital capacity strain is associated with increased mortality and worsened health outcomes. Evidence-based solutions to improve outcomes during times of capacity strain are needed.
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Registered trials
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.