Association between incident occurrence and bed configuration: a retrospective observational study in a Japanese academic hospital during the COVID-19 pandemic.

Objectives: This study examines the relationship between the diversification and complexity of ward operations (DCWO) during the COVID-19 pandemic and incident occurrence. Our hospital faced significant changes in ward management during the pandemic. Typically, each ward accommodates two to four clinical departments, with department assignments remaining relatively fixed. However, to free up beds for patients with COVID-19, the number of general wards was reduced, forcing a more fluid allocation of patients across various departments. This shift resulted in a more complex and diverse departmental mix within each ward, complicating ward operations.

Methods: This study retrospectively examined patients admitted to a university hospital in Japan from 1 April 2020 to 31 March 2022. We analysed incident occurrences by ward (including all inpatients within the target ward) and assessed the relationship between nurse-related incidents and DCWO.

Results: We selected records for 7030 ward days from 21 559 patients admitted (10 336 in 2020 and 11 233 in 2021). No significant difference in average age was observed between fiscal year (FY) 2020 and FY 2021 (62.5±16.6 years vs 62.3±16.8 years, respectively; p=0.69). However, the average length of stay differed (13.6±23.9 days vs 12.9±17.5 days, respectively; p<0.01). Logistic regression analysis revealed an OR for DCWO of 1.008 (95% CI 1.002 to 1.015; p=0.007), indicating that an increase in DCWO was associated with the occurrence of mild incidents (where treatment was not necessary). Multiple regression analyses also revealed the association between DCWO and drug-related incidents (p=0.011) and mild incidents (treatment was not necessary; p=0.010).

Conclusions: Changes in departmental configurations during the COVID-19 pandemic influenced patients' conditions and the frequency of mild incidents, highlighting the importance of patient safety considerations in hospital ward operations.