Investigating Immediate and Intermediate Patient Outcomes Following Transfer From the Acute Medicine Unit at the Western General Hospital, Edinburgh: A Prospective Cohort Study.

Abstract

An ageing population is placing increasing pressure on acute medical units (AMUs), necessitating frequent, and often inappropriate transfer of patients. We identified a gap in the literature, with similar studies relating to either cardiac or intensive care settings, with another, reporting frequency of movement and adverse outcomes in the elderly. The aim of this study was to ascertain whether patients admitted to the AMU and who are moved "out of hours" (22:00-06:59) experience adverse outcomes opposed to patients moved "within hours." Data was extracted from TrakCare-a unified, web-based healthcare information system- which facilitates real-time bed management processes. This prospective cohort study was carried out at the Western General Hospital (WGH), Edinburgh. The final cohort (n = 219) was split into two groups (out of hours vs. within hours) for statistical analysis. Specific sub-group analysis was used to supplement findings, with eight sub-groups, each defined by a 3-hr time frame around the 24-hr clock. The final cohort after application of exclusion criteria was n = 219 (female: n = 114, median age = 76; male: n = 105, median age = 75). There was a significant difference in length of stay (LoS) between boarded and non-boarded patients who were: (1) moved out of hours (2) moved within hours (p = 0.003). Remainder of patient outcome results (readmission at 7 and 30 days respectively; mortality during admission, and at 7 and 30 days) were not statistically significant. We revealed a significant difference in LoS between patients moved within and out with hours; the "out of hours" patient group-was significantly less than that of the "within" hours group.