The Effect of Hospital Isolation Precautions on Patient Outcomes and Cost of Care: A Multi-Site, Retrospective, Propensity Score-Matched Cohort Study

doi:10.1007/s11606-016-3862-4

Multicenter Study

. 2017 Mar;32(3):262-268.

doi: 10.1007/s11606-016-3862-4. Epub 2016 Oct 17.

The Effect of Hospital Isolation Precautions on Patient Outcomes and Cost of Care: A Multi-Site, Retrospective, Propensity Score-Matched Cohort Study

Kim Tran¹, Chaim Bell^{2

3}, Nathan Stall⁴, George Tomlinson^{5

6}, Allison McGeer^{7

8}, Andrew Morris^{9

10}, Michael Gardam^{10

11}, Howard B Abrams^{12

13

14

15}

Affiliations

¹ OpenLab, University Health Network, Toronto, ON, Canada.
² Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
³ Department of Medicine, Division of General Internal Medicine, Mount Sinai Hospital, Toronto, ON, Canada.
⁴ Core Internal Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁶ Department of Medicine, University Health Network, Toronto, ON, Canada.
⁷ Departments of Laboratory Medicine and Pathobiology, Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁸ Department of Microbiology, Division of Infection Control, Mount Sinai Hospital, Toronto, ON, Canada.
⁹ Department of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁰ Department of Medicine, Division of Infectious Diseases, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada.
¹¹ Infectious Diseases and Medicine, University of Toronto, Toronto, ON, Canada.
¹² OpenLab, University Health Network, Toronto, ON, Canada. Howard.abrams@uhn.ca.
¹³ Department of Medicine, University of Toronto, Toronto, ON, Canada. Howard.abrams@uhn.ca.
¹⁴ Department of Medicine, Division of General Internal Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada. Howard.abrams@uhn.ca.
¹⁵ , TGH EN14-218, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. Howard.abrams@uhn.ca.

PMID: 27752880
PMCID: PMC5330996
DOI: 10.1007/s11606-016-3862-4

Multicenter Study

The Effect of Hospital Isolation Precautions on Patient Outcomes and Cost of Care: A Multi-Site, Retrospective, Propensity Score-Matched Cohort Study

Kim Tran et al. J Gen Intern Med. 2017 Mar.

. 2017 Mar;32(3):262-268.

doi: 10.1007/s11606-016-3862-4. Epub 2016 Oct 17.

Authors

Kim Tran¹, Chaim Bell^{2

3}, Nathan Stall⁴, George Tomlinson^{5

6}, Allison McGeer^{7

8}, Andrew Morris^{9

10}, Michael Gardam^{10

11}, Howard B Abrams^{12

13

14

15}

Affiliations

¹ OpenLab, University Health Network, Toronto, ON, Canada.
² Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
³ Department of Medicine, Division of General Internal Medicine, Mount Sinai Hospital, Toronto, ON, Canada.
⁴ Core Internal Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁶ Department of Medicine, University Health Network, Toronto, ON, Canada.
⁷ Departments of Laboratory Medicine and Pathobiology, Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁸ Department of Microbiology, Division of Infection Control, Mount Sinai Hospital, Toronto, ON, Canada.
⁹ Department of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁰ Department of Medicine, Division of Infectious Diseases, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada.
¹¹ Infectious Diseases and Medicine, University of Toronto, Toronto, ON, Canada.
¹² OpenLab, University Health Network, Toronto, ON, Canada. Howard.abrams@uhn.ca.
¹³ Department of Medicine, University of Toronto, Toronto, ON, Canada. Howard.abrams@uhn.ca.
¹⁴ Department of Medicine, Division of General Internal Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada. Howard.abrams@uhn.ca.
¹⁵ , TGH EN14-218, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. Howard.abrams@uhn.ca.

PMID: 27752880
PMCID: PMC5330996
DOI: 10.1007/s11606-016-3862-4

Abstract

Background: Isolation precautions have negative effects on patient safety, psychological well-being, and healthcare worker contact. However, it is not known whether isolation precautions affect certain hospital-related outcomes.

Objective: To examine the effect of isolation precautions on hospital-related outcomes and cost of care.

Design: Retrospective, propensity-score matched cohort study of inpatients admitted to general internal medicine (GIM) services at three academic hospitals in Toronto, Ontario, Canada between January 2010 and December 2012.

Participants: Adult (≥18 years of age) patients on isolation precautions for respiratory illnesses and methicillin-resistant Staphylococcus aureus (MRSA) were matched to controls based on propensity scores derived from nine covariates: age, sex, Resource Intensity Weight, number of hospital readmissions within 90 days, total length of stay for hospital admissions within 90 days, site of admission, month of isolation, year of isolation, and Case Mix Group.

Main measures: Thirty-day readmission rates and emergency department visits, hospital length of stay, expected length of stay, adverse events, in-hospital mortality, patient complaints, and cost of care in Canadian doll ars (CAD).

Key results: A total of 17,649 non-isolated patients were admitted to the participating hospitals during the study period. We identified 1506 patients isolated for respiratory illnesses and 745 patients isolated for MRSA. Compared to non-isolated individuals, those on isolation precautions for respiratory illnesses stayed 17 % longer (95 % CI: 9 %, 25 %), stayed 9 % longer than expected (95 % CI: 3 %, 15 %), and had 23 % higher cost of care (95 % CI: 14 %, 32 %). Patients isolated for MRSA had similar outcomes, but they also had a 4.4 % higher (95 % CI: 1.4 %, 7.3 %) rate of readmission to hospital within 30 days.

Conclusions: Isolation precautions are associated with adverse effects which may result in poorer hospital outcomes. Balancing the benefits for the many with the harms to the few will be a future challenge.

Keywords: Hospital Outcomes; Isolation.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Comment in

Isolation Precautions for Hospitalized Patients: The Challenges of Identifying Unintended Individual Consequences and Measuring the Prevention of Community Harm.
Bowling JE, Taylor BS. Bowling JE, et al. J Gen Intern Med. 2017 Mar;32(3):238-240. doi: 10.1007/s11606-016-3926-5. J Gen Intern Med. 2017. PMID: 27864785 Free PMC article. No abstract available.

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References

1. Garner JS. Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1996;17(1):53–80. doi: 10.2307/30142367. - DOI - PubMed
1. Seto WH, Tsang D, Yung RW, et al. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS) Lancet. 2003;361:1519–20. doi: 10.1016/S0140-6736(03)13168-6. - DOI - PMC - PubMed
1. Loveday HP, Pellowe CM, Jones SRLJ, Pratt RJ. A systematic review of the evidence for interventions for the prevention and control of meticillin-resistant Staphylococcus aureus (1996–2004): report to the Joint MRSA Working Party (Subgroup A) J Hosp Infect. 2006;63(Suppl 1):S45–70. doi: 10.1016/j.jhin.2006.01.002. - DOI - PubMed
1. Burke JP. Infection control - a problem for patient safety. N Engl J Med. 2003;348(7):651–6. doi: 10.1056/NEJMhpr020557. - DOI - PubMed
1. Kirkland KB. Taking off the gloves: toward a less dogmatic approach to the use of contact isolation. Clin Infect Dis. 2009;48(6):766–71. doi: 10.1086/597090. - DOI - PubMed

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[1] Garner JS. Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1996;17(1):53–80. doi: 10.2307/30142367. - DOI - PubMed

[2] Garner JS. Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1996;17(1):53–80. doi: 10.2307/30142367. - DOI - PubMed

[3] Seto WH, Tsang D, Yung RW, et al. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS) Lancet. 2003;361:1519–20. doi: 10.1016/S0140-6736(03)13168-6. - DOI - PMC - PubMed

[4] Seto WH, Tsang D, Yung RW, et al. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS) Lancet. 2003;361:1519–20. doi: 10.1016/S0140-6736(03)13168-6. - DOI - PMC - PubMed

[5] Loveday HP, Pellowe CM, Jones SRLJ, Pratt RJ. A systematic review of the evidence for interventions for the prevention and control of meticillin-resistant Staphylococcus aureus (1996–2004): report to the Joint MRSA Working Party (Subgroup A) J Hosp Infect. 2006;63(Suppl 1):S45–70. doi: 10.1016/j.jhin.2006.01.002. - DOI - PubMed

[6] Loveday HP, Pellowe CM, Jones SRLJ, Pratt RJ. A systematic review of the evidence for interventions for the prevention and control of meticillin-resistant Staphylococcus aureus (1996–2004): report to the Joint MRSA Working Party (Subgroup A) J Hosp Infect. 2006;63(Suppl 1):S45–70. doi: 10.1016/j.jhin.2006.01.002. - DOI - PubMed

[7] Burke JP. Infection control - a problem for patient safety. N Engl J Med. 2003;348(7):651–6. doi: 10.1056/NEJMhpr020557. - DOI - PubMed

[8] Burke JP. Infection control - a problem for patient safety. N Engl J Med. 2003;348(7):651–6. doi: 10.1056/NEJMhpr020557. - DOI - PubMed

[9] Kirkland KB. Taking off the gloves: toward a less dogmatic approach to the use of contact isolation. Clin Infect Dis. 2009;48(6):766–71. doi: 10.1086/597090. - DOI - PubMed

[10] Kirkland KB. Taking off the gloves: toward a less dogmatic approach to the use of contact isolation. Clin Infect Dis. 2009;48(6):766–71. doi: 10.1086/597090. - DOI - PubMed

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The Effect of Hospital Isolation Precautions on Patient Outcomes and Cost of Care: A Multi-Site, Retrospective, Propensity Score-Matched Cohort Study

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The Effect of Hospital Isolation Precautions on Patient Outcomes and Cost of Care: A Multi-Site, Retrospective, Propensity Score-Matched Cohort Study

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