Medical outliers – effects on mortality, length of stay and unplanned readmissions

From an international perspective, Sweden has relatively few hospital beds per capita and the existing hospital beds are often designated for highly specialized care.

In recent years, the number of medical outliers have been increasing in Sweden which is a threat to patient safety as the receiving hospital ward often lack the expertise and procedures to care for the outlying patient.The scientific evidence on the risks associated with medical outliers is diverse and demonstrates counter-intuitive results, possibly due to the varying methodological quality of existing studies.As the evidence regarding effects of medical outliers is difficult to interpret, the aim of the project is to investigate how bedspacing affects patient safety and how the risks of bedspacing are affected by patient characteristics and the healthcare organization.The project intends to answer four research questions.

The first research question will investigate the patient composition of medical outliers based on diagnoses, socioeconomic factors, age and sex. The second research question investigates if patienty safety is affected by bedspacing.

Research questions three and four will investigate if the result from research question two can be explained by patient characteristics and/or structural factors related to hospitals.The feasibility of the project have been confirmed in a pilot study in collaboration with Dalarna Region who, together with three more Swedish regions will constitute the data sources for this project.