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The Impact of Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus (VRE) Flags on Hospital Operations

Published online by Cambridge University Press:  29 March 2016

Erica S. Shenoy ,
Hang Lee ,
Taige Hou ,
Winston Ware ,
Erin E. Ryan ,
David C. Hooper  and
Rochelle P. Walensky
Erica S. Shenoy*
Affiliation:
Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
Hang Lee
Affiliation:
Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts
Taige Hou
Affiliation:
Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts
Winston Ware
Affiliation:
Clinical Care Management Unit, Massachusetts General Hospital, Boston, Massachusetts
Erin E. Ryan
Affiliation:
Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts
David C. Hooper
Affiliation:
Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
Rochelle P. Walensky
Affiliation:
Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
*
Address correspondence to Erica S. Shenoy, MD, PhD, 55 Fruit Street, Bulfinch 334, Infection Control Unit, Massachusetts General Hospital, Boston, MA 02114 (eshenoy@partners.org).
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Abstract

OBJECTIVE

To determine the impact of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus (MRSA/VRE) designations, or flags, on selected hospital operational outcomes.

DESIGN

Retrospective cohort study of inpatients admitted to the Massachusetts General Hospital during 2010–2011.

METHODS

Operational outcomes were time to bed arrival, acuity-unrelated within-hospital transfers, and length of stay. Covariates considered included demographic and clinical characteristics: age, gender, severity of illness on admission, admit day of week, residence prior to admission, hospitalization within the prior 30 days, clinical service, and discharge destination.

RESULTS

Overall, 81,288 admissions were included. After adjusting for covariates, patients with a MRSA/VRE flag at the time of admission experienced a mean delay in time to bed arrival of 1.03 hours (9.63 hours [95% CI, 9.39–9.88] vs 8.60 hours [95% CI, 8.47–8.73]). These patients had 1.19 times the odds of experiencing an acuity-unrelated within-hospital transfer [95% CI, 1.13–1.26] and a mean length of stay 1.76 days longer (7.03 days [95% CI, 6.82–7.24] vs 5.27 days [95% CI, 5.15–5.38]) than patients with no MRSA/VRE flag.

CONCLUSIONS

MRSA/VRE designation was associated with delays in time to bed arrival, increased likelihood of acuity-unrelated within-hospital transfers and extended length of stay. Efforts to identify patients who have cleared MRSA/VRE colonization are critically important to mitigate inefficient use of resources and to improve inpatient flow.

Infect Control Hosp Epidemiol 2016;37:782–790

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 7 , July 2016 , pp. 782 - 790
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

a

Authors with equal contribution.

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