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15.12.2016 | Review Paper | Ausgabe 6/2017

Journal of General Internal Medicine 6/2017

The Association Between Hospital Capacity Strain and Inpatient Outcomes in Highly Developed Countries: A Systematic Review

Zeitschrift:
Journal of General Internal Medicine > Ausgabe 6/2017
Autoren:
MD, MPH Carl O. Eriksson, PhD Ryan C. Stoner, PhD Karen B. Eden, MD, MPH Craig D. Newgard, MD, MPH Jeanne-Marie Guise
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s11606-016-3936-3) contains supplementary material, which is available to authorized users.
Registration: International Prospective Register of Systematic Reviews (PROSPERO), Registration No. CRD42015024758

Abstract

Background

Increases 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.

Methods

Parallel 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.

Results

Of 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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