A new concern for patients in
the hospital: distractions caused by the misfortune of other patients has been described by University of Chicago physicians. The study is published in the JAMA.
The researchers found that when one patient on a typical 20-bed
hospital unit took a turn for the worse - a cardiac arrest, for example,
or being transferred to an intensive-care unit - the other patients on
that ward were at increased risk for their own setbacks.
‘A critical-illness event increases the odds that a second patient in the same unit would undergo a comparable crisis.’
In the six hours after a critical-illness event, the odds that a
second patient in the same unit would undergo a comparable crisis
increased by about 18%. If there were two such events during a
six-hour time period, the risk of yet another occurrence went up by
about 53%. Risks were slightly higher when the initial critical
illness events occurred at night.
Cardiac arrests, urgent ICU transfers or patient deaths were also
associated with delayed discharge from the hospital for the other
patients on the same unit.
"This should serve as a wake-up call for hospital-based physicians,"
said study author Matthew Churpek, assistant professor of
medicine at the University of Chicago.
"Our data suggests that after caring for a patient who becomes
critically ill on the hospital wards, we should routinely check to see
how the other patients on the unit are doing," Churpek said.
"Following these high-intensity events, our to-do list should
include a thorough assessment of the other patients on the unit, to make
sure none of them are at risk of slipping through the cracks."
Luckily, such events were relatively rare. Nearly 84,000 adult
patients were admitted to non-ICU beds at the University of Chicago
Medicine from 2009 to 2013. About 5% of those patients were
subsequently transferred to an intensive-care unit (4,107) or
experienced an in-hospital cardiac arrest (179).
Patients who had a cardiac arrest or required ICU transfer tended to
be a few years older and male. They had been in the hospital, on
average, for 13 days, four times longer than patients who did not have a
"We suspected this phenomenon based on our own anecdotal
experience," said co-author Samuel Volchenboum, associate
professor of pediatrics at the University of Chicago and director of the
University's Center for Research Informatics. "But until we had access
to a large, well-curated research-data warehouse, we couldn't perform a
study like this."
"Very few academic centers have access to the kinds of high-quality
data needed to perform this type of investigation," he added.
The study was designed to detect and quantify any increased risk to
neighboring patients. The researchers speculate that one potential
factor may be that doctors and nurses could have been "temporarily
diverted to help care for critically ill patients," Volchenboum said.
"Further study is needed to determine the causes of this effect."