Clinical outcomes in medical outliers admitted to hospital with heart failure

Background: Due to the lack of beds in medical wards, many patients are placed in other departments' wards (usually in surgical wards). These patients are called "medical outliers". This is a common problem in countries with public national health services. We determined whether location influences progress and prognosis of patients. Methods: This was a retrospective cohort study in a public university hospital in Madrid, Spain. 243 patients discharged from the Department of Internal Medicine during 2006 with the same diagnosis-related group (DRG) (congestive heart failure and cardiac arrhythmia with major complications or comorbidity) were studied. Patients admitted to departments other than the Internal Medicine department or Intensive Care Unit were excluded. "Medical outlier" was defined as a patient admitted to a ward different from the internal Medicine ward. Medical outliers transferred to the Internal Medicine ward were not excluded. Results: 109 (45%) patients were medical outliers. They had a longer stay in hospital (mean difference 2.6 days, 95% confidence interval 0.6-4.7) but with no statistically significant differences in mortality, readmission, or intra-hospital morbidity. These patterns persisted after control for confounding in multivariate analysis. Conclusion: Patients admitted to the Department of Internal Medicine with heart failure had a longer stay if they initially start in other departments' wards. Significant differences were not seen in this group of patients with respect to mortality, readmission, or intra-hospital morbidity. (C) 2009 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.