Patients at small urban hospitals are more likely to suffer from pressure sores than those at small rural hospitals
Earlier studies have shown better patient safety outcomes and lower adverse event rates at rural hospitals compared with their urban counterparts. However, such studies usually compare larger, teaching hospitals in urban areas with smaller, rural hospitals. Now, a new study has evened the playing field by focusing exclusively on small urban and rural hospitals with fewer than 100 beds. It found that observed rates of patient safety problems were higher for small urban hospitals compared with small rural hospitals. However, after adjusting for patient and hospital characteristics, most of these differences disappeared, with the exception of decubitus ulcers (pressure sores due to not being regularly turned in the bed or wheelchair). In this case, small urban hospitals had significantly worse outcomes for this condition than small rural hospitals.
Researchers used data from an annual national survey of hospitals as well as data from a sample of hospital discharge information to examine patient safety outcomes at 185 small rural and 107 small urban hospitals. They used patient safety indicator (PSI) software developed by the Agency for Healthcare Research and Quality (AHRQ) to examine nine common patient safety outcomes at the hospitals. These included such things as anesthesia complications, postoperative hemorrhage, and decubitus ulcer.
Rates for the nine PSIs were higher for the small urban hospitals than for small rural hospitals. Patients admitted to small urban hospitals had significantly higher risks for decubitus ulcer, infections due to medical care, and accidental puncture or laceration. Those admitted to small rural hospitals were at greater risk for anesthesia complications. However, after the researchers adjusted for relevant hospital and patient characteristics, many of these differences disappeared. Only patients admitted to small urban hospitals were found to have a higher risk for decubitus ulcer. This may be due to the higher rates of surgical and emergency admissions found at these urban hospitals, suggest the researchers. Their study was supported in part by AHRQ (HS15009).
See "Patient safety outcomes in small urban and small rural hospitals," by Smruti Vartak, M.P.H., Marcia M. Ward, Ph.D., and Thomas E. Vaughn, Ph.D., in the Journal of Rural Health 26, pp. 58-66, 2010.
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