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March 19, 2010

The Worst Time for a Hospital Visit

"This week in 'Doctor and Patient,' I write about how four factors — hospital occupancy, weekend admissions, nurse staffing and the seasonal flu — can not only increase the risk of dying in a hospital but can also interact in variable ways.

"The result of this interplay, according to a study published this month in the journal Medical Care, is that each hospital has a unique threshold — its own “fingerprint,” according to one of the study authors — beyond which patient safety becomes compromised. One hospital may find that a four-to-one patient-to-nurse ratio and 70 percent occupancy borders on hazardous, whereas another hospital that serves a healthier population will work efficiently at the same staffing ratio until at least 90 percent of the beds are occupied. ...

"Dr. Matthew Davis, an associate professor of pediatrics, internal medicine and public policy at the University of Michigan and senior author of the study, suggested that patients get their seasonal flu vaccinations and speak to their doctors about the timing of their procedure or admission, particularly in relation to the hospital’s overall work flow. 'I think that would be a particularly good conversation for people planning to have elective surgery,' Dr. Davis said. 'Not all of this improvement in safety has to happen within the fours walls of a hospital.'"

Read more in New York Times, March 18, 2010.