Observational studyBMJ open2017
Are medical outliers associated with worse patient outcomes? A retrospective study within a regional NHS hospital using routine data.
Observational study in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
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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.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it, 56 citations in OpenAlex.
- What Quality and Safety of Care for Patients Admitted to Clinically Inappropriate Wards: a Systematic Review.Journal of general internal medicine · 2019Pooled it
- Hospital ward transitions and outcomes in critical care survivors: A multi-hospital cohort study.Journal of the Intensive Care Society · 2026Article
- Designing Governance Boundaries for Hospital Bed Management: Balancing Centralized Pooling and Local Protection.Healthcare (Basel, Switzerland) · 2026Article
- Strategies for Reducing Access Block and Waiting Time for Patients Seeking Emergency Hospital Care: Results of a Ward-Level Discrete Event Simulation at Queensland's Largest Public Hospitals.The Medical journal of Australia · 2026Article
- Impact of skilled nursing facility discharge on inpatient oncology quality outcomes.JNCI cancer spectrum · 2025Article
- Addressing the Knowledge Deficit in Hospital Bed Planning and Defining an Optimum Region for the Number of Different Types of Hospital Beds in an Effective Health Care System.International journal of environmental research and public health · 2023Review
- The impact of atypical intrahospital transfers on patient outcomes: a mixed methods study.Scientific reports · 2023Article
- Admission of kidney patients to a closed staff nephrology department results in a better short-term survival.PloS one · 2023Article
- Analysis of the management of ventriculitis cases at a UK neurosurgery centre.Infection prevention in practice · 2022Article
- Development of an acute medical unit to optimize patient flow and early discharges in a tertiary care hospital in the United Arab Emirates.BMC health services research · 2022Review
- Machine learning for real-time aggregated prediction of hospital admission for emergency patients.NPJ digital medicine · 2022Article
- High ward occupancy, bedspacing, and 60 day mortality for patients with myocardial infarction, stroke, and heart failure.ESC heart failure · 2022Article
- Response to winter pressures in acute services: analysis from the Winter Society for Acute Medicine Benchmarking Audit.BMC health services research · 2022Article
- Patient safety, quality of care and missed nursing care at a cardiology department during the COVID-19 outbreak.Nursing open · 2022Article
- Influence of bedspacing on outcomes of hospitalised medicine service patients: a retrospective cohort study.BMJ quality & safety · 2021Article
- Comparing the association of cardiovascular nursing care with blood pressure and length of stay of in-patients with coronary artery disease in Wuhan, China.African health sciences · 2020Article
- The Frontline Nurse's Experience of Nursing Outlier Patients.International journal of environmental research and public health · 2020Article
- A qualitative exploration of escalation of care in the acute ward setting.Nursing in critical care · 2020Article
- Streamlining communication between nursing staff and medical teams regarding patients who are 'medical outliers'.Future healthcare journal · 2019Article
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo explore the quality and safety of patients' healthcare provision by identifying whether being a medical outlier is associated with worse patient outcomes. A medical outlier is a hospital inpatient who is classified as a medical patient for an episode within a spell of care and has at least one non-medical ward placement within that spell. DATA SOURCES: Secondary data from the Patient Administration System of a district general hospital were provided for the financial years 2013/2014-2015/2016. The data included 71 038 medical patient spells for the 3-year period. STUDY
designThis research was based on a retrospective, cross-sectional observational study design. Multivariate logistic regression and zero-truncated negative binomial regression were used to explore patient outcomes (in-hospital mortality, 30-day mortality, readmissions and length of stay (LOS)) while adjusting for several confounding factors. PRINCIPAL
findingsUnivariate analysis indicated that an outlying medical in-hospital patient has higher odds for readmission, double the odds of staying longer in the hospital but no significant difference in the odds of in-hospital and 30-day mortality. Multivariable analysis indicates that being a medical outlier does not affect mortality outcomes or readmission, but it does prolong LOS in the hospital.
conclusionsAfter adjusting for other factors, medical outliers are associated with an increased LOS while mortality or readmissions are not worse than patients treated in appropriate specialty wards. This is in line with existing but limited literature that such patients experience worse patient outcomes. Hospitals may need to revisit their policies regarding outlying patients as increased LOS is associated with an increased likelihood of harm events, worse quality of care and increased healthcare costs.
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