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Wessman T, Ärnlöv J, Carlsson AC, Ekelund U, Wändell P, Melander O, Ruge T. The association between length of stay in the emergency department and short-term mortality. Intern Emerg Med 2022; 17:233-240. [PMID: 34110561 PMCID: PMC8841314 DOI: 10.1007/s11739-021-02783-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022]
Abstract
The detrimental effects of increased length of stay at the emergency department (ED-LOS) for patient outcome have been sparsely studied in the Swedish setting. Our aim was to further explore the association between ED-LOS and short-term mortality in patients admitted to the EDs of two large University hospitals in Sweden. All adult patients (> 18 years) visiting the ED at the Karolinska University Hospital, Sweden, from 1/1/2010 to 1/1/2015 (n = 639,385) were retrospectively included. Logistic regression analysis was used to determine association between ED-LOS and 7- and 30-day mortality rates. All patients were triaged according to the RETTS-A into different levels of medical urgency and subsequently separated into five quintiles of ED-LOS. Mortality rate was highest in highest triage priority level (7-day mortality 5.24%, and 30-day mortality 9.44%), and decreased by lower triage priority group. For patients with triage priority levels 2-4, prolonged ED-LOS was associated with increased mortality, especially for lowest priority level, OR for priority level 4 and highest quintile of ED-LOS 30-day mortality 1.49 (CI 95% 1.20-1.85). For patients with highest triage priority level the opposite was at hand, with decreasing mortality risk with increasing quintile of ED-LOS for 7-day mortality, and lower mortality for the two highest quintile of ED-LOS for 30-day mortality. In patients not admitted to in-hospital care higher ED-LOS was associated with higher mortality. Our data suggest that increased ED-LOS could be associated with slightly increased short-term mortality in patients with lower clinical urgency and dismissed from the ED.
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Affiliation(s)
- Torgny Wessman
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
- grid.411843.b0000 0004 0623 9987Emergency Department, Skåne University Hospital, Malmö, Sweden
| | - Johan Ärnlöv
- grid.4714.60000 0004 1937 0626Division for Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- grid.411953.b0000 0001 0304 6002School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Axel Carl Carlsson
- grid.4714.60000 0004 1937 0626Division for Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Ulf Ekelund
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Lund, Emergency Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| | - Per Wändell
- grid.4714.60000 0004 1937 0626Division for Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Olle Melander
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
- grid.411843.b0000 0004 0623 9987Emergency Department, Skåne University Hospital, Malmö, Sweden
| | - Toralph Ruge
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
- grid.411843.b0000 0004 0623 9987Emergency Department, Skåne University Hospital, Malmö, Sweden
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Capone F, Molinari L, Noale M, Previato L, Giannini S, Vettore G, Fabris F, Saller A. Admission criteria for a cardiovascular short stay unit: a retrospective analysis on a pilot unit. Intern Emerg Med 2021; 16:2087-2095. [PMID: 33770369 PMCID: PMC8563614 DOI: 10.1007/s11739-021-02700-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
Rapid intensive observation (RIO) units have been created to guarantee high standards of care in a sustainable health-care system. Within short stay units (SSUs), which are a subgroup of RIOs, only rapidly manageable patients should be admitted. Physicians are unable to predict the length of stay (LOS) as objective criteria to make such a prediction are missing. A retrospective observational study was carried out to identify the objective criteria for admission within a cardiovascular care-oriented SSU. Over a period of 317 days, 340 patients (age 69.4 ± 14.7 years) were admitted to a pilot SSU within our internal medicine department. The most frequent diagnoses were chest pain (45.9%), syncope (12.9%), and supraventricular arrhythmias (11.2%). The median LOS was 4 days (quartile 1:3; quartile 3:7). Predictors of LOS ≤ 96 h were age < 80, hemoglobin > 115 g/L, estimated glomerular filtration rate > 45 mL/min/1.73 m2, Charlson Comorbidity Index < 3, Barthel Index > 40, diagnosis of chest pain, syncope, supraventricular arrhythmias, or acute heart failure. The HEART (history, ECG, age, risk factors, troponin) score was found to be excellent in risk stratification of patients admitted for chest pain. Blood tests and anamnestic variables can be used to predict the LOS and thus SSU admission. The HEART score may help in the classification of patients with chest pain admitted to an SSU.
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Affiliation(s)
- Federico Capone
- Department of Medicine, University of Padova Medical School, University of Padua, Padua, Italy.
| | - Leonardo Molinari
- Department of Medicine, University of Padova Medical School, University of Padua, Padua, Italy
| | - Marianna Noale
- Neuroscience Institute, Aging Branch, National Research Council (CNR), Padua, Italy
| | - Lorenzo Previato
- Department of Medicine, University of Padova Medical School, University of Padua, Padua, Italy
| | - Sandro Giannini
- Department of Medicine, University of Padova Medical School, University of Padua, Padua, Italy
| | - Gianna Vettore
- Department of Urgent and Emergency Care, University of Padova, Padua, Italy
| | - Fabrizio Fabris
- Department of Medicine, University of Padova Medical School, University of Padua, Padua, Italy
| | - Alois Saller
- Department of Medicine, University of Padova Medical School, University of Padua, Padua, Italy
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Dinh MM, Arce CP, Berendsen Russell S, Bein KJ. Predictors and in‐hospital mortality associated with prolonged emergency department length of stay in New South Wales tertiary hospitals from 2017 to 2018. Emerg Med Australas 2020; 32:611-617. [DOI: 10.1111/1742-6723.13477] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Michael M Dinh
- Emergency DepartmentRoyal Prince Alfred Hospital, RPA Green Light Institute for Emergency Care Sydney New South Wales Australia
| | - Chantel P Arce
- Sydney Medical SchoolThe University of Sydney Sydney New South Wales Australia
| | - Saartje Berendsen Russell
- Emergency DepartmentRoyal Prince Alfred Hospital, RPA Green Light Institute for Emergency Care Sydney New South Wales Australia
| | - Kendall J Bein
- Emergency DepartmentRoyal Prince Alfred Hospital, RPA Green Light Institute for Emergency Care Sydney New South Wales Australia
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Reid LEM, Pretsch U, Jones MC, Lone NI, Weir CJ, Morrison Z. The acute medical unit model: A characterisation based upon the National Health Service in Scotland. PLoS One 2018; 13:e0204010. [PMID: 30281643 PMCID: PMC6169877 DOI: 10.1371/journal.pone.0204010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 08/31/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Acute medical units (AMUs) receive the majority of acute medical patients presenting to hospital as an emergency in the United Kingdom (UK) and in other international settings. They have emerged as a result of local service innovation in the context of a limited evidence base. As such, the AMU model is not well characterised in terms of its boundaries, patient populations and components of care. This makes service optimisation and development through strategic resource planning, quality improvement and research challenging. AIM This study aims to evaluate a national set of AMUs with the intent of characterising the AMU model. METHODS Twenty-nine AMUs in Scotland were identified. Data were collected by semi-structured interviews with multidisciplinary healthcare professionals working in each AMU. A draft report was produced for each unit and verified by a unit representative. The unit reports were then analysed to develop a conceptual framework of key components of AMUs and a service definition of the boundaries of acute medical care. RESULTS Acute medical care in Scotland can be described as being delivered in "acute medical services" rather than geographically distinct AMUs. Twelve key components of AMU care were identified: care areas, functions, populations, patient flow, support services, communication, nurse care, allied healthcare professional care, non-consultant medical care, consultant care, patient assessment and specialty care. DISCUSSION This empirically derived characterisation of the AMU model is likely to be of utility to practitioners, managers, policy makers and researchers: it is relevant on an operational level, will aid quality improvement and is a foundation to needed further research into how best to deliver care in AMUs. This is important given the central role AMUs play in the journey of the majority of patients presenting to hospital acutely in Scotland, the UK and internationally.
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Affiliation(s)
- Lindsay E. M. Reid
- Development and Delivery Department, Ko Awatea Health Systems Innovation and Improvement, Auckland, New Zealand
- Quality, Research and Standards, Royal College of Physicians of Edinburgh, Edinburgh, United Kingdom
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Ursula Pretsch
- Quality, Research and Standards, Royal College of Physicians of Edinburgh, Edinburgh, United Kingdom
| | - Michael C. Jones
- Quality, Research and Standards, Royal College of Physicians of Edinburgh, Edinburgh, United Kingdom
| | - Nazir I. Lone
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Christopher J. Weir
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Clinical Trials Unit; University of Edinburgh, Edinburgh, United Kingdom
| | - Zoe Morrison
- Business School, University of Aberdeen, Aberdeen, United Kingdom
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Woodward T, Hocking J, James L, Johnson D. Impact of an emergency department‐run clinical decision unit on access block, ambulance ramping and National Emergency Access Target. Emerg Med Australas 2018; 31:200-204. [PMID: 30014624 DOI: 10.1111/1742-6723.13110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 04/16/2018] [Accepted: 05/01/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Thomas Woodward
- Emergency DepartmentHervey Bay Hospital Hervey Bay Queensland Australia
- Emergency DepartmentRoyal Devon and Exeter Hospital Exeter Devon UK
| | - Julia Hocking
- Emergency Medicine Foundation Brisbane Queensland Australia
- School of Psychology and CounsellingQueensland University of Technology Brisbane Queensland Australia
| | - Lucy James
- Emergency DepartmentHervey Bay Hospital Hervey Bay Queensland Australia
- Emergency DepartmentRoyal Devon and Exeter Hospital Exeter Devon UK
| | - David Johnson
- Emergency DepartmentHervey Bay Hospital Hervey Bay Queensland Australia
- Rural Clinical SchoolThe University of Queensland Hervey Bay Queensland Australia
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Reid LEM, Lone NI, Morrison ZJ, Weir CJ, Jones MC. The provision of seven day multidisciplinary staffing in Scottish acute medical units: a cross-sectional study. QJM 2018; 111:295-301. [PMID: 29408979 DOI: 10.1093/qjmed/hcy024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Acute medical units (AMUs) are a central component of the admission pathway for the majority of medical patients presenting to hospital in the United Kingdom and other international settings. Detail on multidisciplinary staffing provision on weekdays and weekends is lacking. Equity of staffing across 7 days is a strategic priority for national health services in the United Kingdom. AIM To evaluate weekday compared with weekend multidisciplinary staffing in a national set of AMUs. DESIGN Cross-sectional survey. METHODS Twenty-nine Scottish AMUs were identified and all were included in the study population. Data were collected by semi-structured interviews with nursing, pharmacy, therapy, non-consultant medical and consultant staff. Staffing was quantified in staff hours. A correction factor of 0.5 was applied to non-dedicated staff. The percentage of weekend/weekday staffing was calculated for each unit and the mean of these percentages was calculated to give a summary measure for each professional group. RESULTS As a percentage of weekday staffing levels, weekend staffing across the units was 93.8% for nursing staff; 2.2% for pharmacy staff; 13.1% for therapy staff; 69.6% for non-consultant staff and 65.0% for consultant staff. CONCLUSIONS There is a contrast between weekday and weekend staffing on the AMU, with reductions at weekends in total staff hours, the proportion of dedicated vs. undedicated staff and the seniority of nursing staff. The weekday/weekend difference was far more pronounced for allied healthcare professional staff than any other group. These findings have potential implications for patient outcomes, quality of care, hospital flow and workforce planning.
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Affiliation(s)
- L E M Reid
- Department of Development and Delivery, Ko Awatea Health Systems Innovation and Improvement, Middlemore Hospital, 54/100 Hospital Rd, Auckland 2025, New Zealand
- Quality, Research and Standards, Royal College of Physicians of Edinburgh, 9 Queen Street, Edinburgh EH2 1JQ, UK
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh EH8 9AG, UK
| | - N I Lone
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh EH8 9AG, UK
| | - Z J Morrison
- Business School, University of Aberdeen, Edward Wright Building, Dunbar Street, Aberdeen AB24 3QY, UK
| | - C J Weir
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh EH8 9AG, UK
- Edinburgh Clinical Trials Unit, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh EH8 9AG, UK
| | - M C Jones
- Quality, Research and Standards, Royal College of Physicians of Edinburgh, 9 Queen Street, Edinburgh EH2 1JQ, UK
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Meschi T, Ticinesi A, Prati B, Montali A, Ventura A, Nouvenne A, Borghi L. A novel organizational model to face the challenge of multimorbid elderly patients in an internal medicine setting: a case study from Parma Hospital, Italy. Intern Emerg Med 2016; 11:667-76. [PMID: 26846233 DOI: 10.1007/s11739-016-1390-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 01/09/2016] [Indexed: 11/25/2022]
Abstract
Continuous increase of elderly patients with multimorbidity and Emergency Department (ED) overcrowding are great challenges for modern medicine. Traditional hospital organizations are often too rigid to solve them without consistently rising healthcare costs. In this paper we present a new organizational model achieved at Internal Medicine and Critical Subacute Care Unit of Parma University Hospital, Italy, a 106-bed internal medicine area organized by intensity of care and specifically dedicated to such patients. The unit is partitioned into smaller wards, each with a specific intensity level of care, including a rapid-turnover ward (mean length of stay <4 days) admitting acutely ill patients from the ED, a subacute care ward for chronic critically ill subjects and a nurse-managed ward for stable patients who have socio-economic trouble preventing discharge. A very-rapid-turnover ("come'n'go") ward has also been instituted to manage sudden ED overflows. Continuity, effectiveness, safety and appropriateness of care are guaranteed by an innovative figure called "flow manager," with skilled clinical experience and managerial attitude, and by elaboration of an early personalized discharge plan anticipating every patient's needs according to lean methodology principles. In 2012-2014, this organizational model, compared with other peer units of the hospital and of other teaching hospitals of the region, showed a better performance, efficacy and effectiveness indexes calculated on Regional Hospital Discharge Records database system, allowing a capacity to face a massive (+22 %) rise in medical admissions from the ED. Further studies are needed to validate this model from a patient outcome point of view.
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Affiliation(s)
- Tiziana Meschi
- Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital and Clinical and Experimental Medicine Department, University of Parma, Via A. Gramsci 14, 43126, Parma, Italy.
| | - Andrea Ticinesi
- Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital and Clinical and Experimental Medicine Department, University of Parma, Via A. Gramsci 14, 43126, Parma, Italy
| | - Beatrice Prati
- Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital and Clinical and Experimental Medicine Department, University of Parma, Via A. Gramsci 14, 43126, Parma, Italy
| | | | - Antonio Ventura
- Business Management Control Unit, General Management Direction, Parma University Hospital, Parma, Italy
| | - Antonio Nouvenne
- Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital and Clinical and Experimental Medicine Department, University of Parma, Via A. Gramsci 14, 43126, Parma, Italy
| | - Loris Borghi
- Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital and Clinical and Experimental Medicine Department, University of Parma, Via A. Gramsci 14, 43126, Parma, Italy
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Reid LEM, Dinesen LC, Jones MC, Morrison ZJ, Weir CJ, Lone NI. The effectiveness and variation of acute medical units: a systematic review. Int J Qual Health Care 2016; 28:433-46. [PMID: 27313174 DOI: 10.1093/intqhc/mzw056] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2016] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate the evidence for the effectiveness of acute medical units (AMUs) compared with other models of care and compare the components of AMU models. DATA SOURCES Six electronic databases and grey literature sources searched between 1990 and 2014. STUDY SELECTION Studies reporting on AMUs as an intervention for unplanned medical presentations to hospital with the inclusion of all outcome measures/study designs/comparators. DATA EXTRACTION Data on study characteristics/outcomes/AMU components were extracted by one author and confirmed by a second. DATA SYNTHESIS Seventeen studies of 12 AMUs across five countries were included. The AMU model was associated with a reduction in-hospital length of stay (LOS) in all analyses ranging from 0.3 to 2.6 days; and a reduction in mortality in 12 of the 14 analyses with the change ranging from a 0.1% increase to a 8.8% reduction. Evidence relating to readmissions and patient/staff satisfaction was less conclusive. There was variation in the following components of AMUs: admission criteria, entry sources, functions and consultant work patterns. CONCLUSION This review provides evidence that AMUs are associated with reductions in-hospital LOS and, less convincingly, mortality compared with other models of care when implemented in European and Australasian settings. Reported estimates may be affected by residual confounding. This review reports heterogeneity in components of the AMU model. Further work to identify what constitutes the key components of an AMU is needed to improve the quality and effectiveness of acute medical care. This is of particular importance given the escalating demand on acute services.
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Affiliation(s)
- Lindsay E M Reid
- The Royal College of Physicians of Edinburgh, Quality, Research and Standards Office, 9 Queen Street, EH2 1JQ Edinburgh, UK Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Michael C Jones
- The Royal College of Physicians of Edinburgh, Quality, Research and Standards Office, 9 Queen Street, EH2 1JQ Edinburgh, UK
| | | | - Christopher J Weir
- Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK Edinburgh Clinical Trials Unit, Edinburgh, UK
| | - Nazir I Lone
- Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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Abstract
Acute medicine and acute medical units are relatively new innovations. The evolving evidence base is demonstrating the effectiveness of these in improving care given to patients with acute medical illness. This article reviews the available evidence.
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Affiliation(s)
- Mike Jones
- Acute Medicine, University Hospital of North Durham, Durham, UK
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Ulltang M, Vivanti AP, Murray E. Malnutrition prevalence in a medical assessment and planning unit and its association with hospital readmission. AUST HEALTH REV 2014; 37:636-41. [PMID: 24200115 DOI: 10.1071/ah13051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 07/14/2013] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To investigate malnutrition prevalence on presentation to a Medical Assessment and Planning Unit (MAPU) in a setting designed to prevent hospital admission, the association of nutritional status with hospital readmission at 90 days, and agreement of nutritional risk between the Malnutrition Screening Tool (MST) and Subjective Global Assessment (SGA). METHODS Prospective longitudinal cohort study of consecutive patients admitted to MAPU during the first 6 weeks of operation. The main outcome measures were prevalence of malnutrition and hospital readmission at 90 days. Sensitivity and specificity of the MST was assessed against the criterion standard of SGA. RESULTS The mean participant age was 62 years (n = 153, s.d. 17.4 years) with 50% male (77/153, 95% CI 42-58%). According to the SGA, 17% (95% CI 8-26%) were assessed as malnourished on admission. The MST identified that 18% (95% CI 12-24%) were at nutritional risk, and participants screening positive for nutritional risk had significantly increased odds of hospital readmission at 90 days (OR 3.4, 95% CI, 1.3-9.1, P < 0.029). The MST was practical and successfully identified patients assessed as malnourished within the MAPU setting (sensitivity 73%, specificity 76%, negative predictive value 93%, positive predictive value 38%). CONCLUSIONS Malnutrition is a significant problem in a MAPU setting, and patients screened at nutritional risk are at significantly higher risk of hospital readmission within 90 days.
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Affiliation(s)
- Marte Ulltang
- Queensland University of Technology, Victoria Park Road, Kelvin Grove, Qld 4059, Australia
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Schultz H, Qvist N, Mogensen CB, Pedersen BD. Experiences of patients with acute abdominal pain in the ED or acute surgical ward – A qualitative comparative study. Int Emerg Nurs 2013; 21:228-35. [DOI: 10.1016/j.ienj.2013.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 01/17/2013] [Accepted: 01/21/2013] [Indexed: 12/30/2022]
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Casalino E, Wargon M, Peroziello A, Choquet C, Leroy C, Beaune S, Pereira L, Bernard J, Buzzi JC. Predictive factors for longer length of stay in an emergency department: a prospective multicentre study evaluating the impact of age, patient's clinical acuity and complexity, and care pathways. Emerg Med J 2013; 31:361-8. [PMID: 23449890 DOI: 10.1136/emermed-2012-202155] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND It has been reported that emergency department length of stay (ED-LOS) for older patients is longer than average. Our objective was to determine the effect of age, patient's clinical acuity and complexity, and care pathways on ED-LOS and ED plus observation unit (EDOU) LOS (EDOU-LOS). METHODS This was a prospective, multicentre, observational study including all patients attending in 2011. Age groups were: I, <50; II, ≥50-64; III, ≥65-74; IV, ≥75-84; V, ≥85 years. Univariate and multivariate analyses were performed. RESULTS Of 125 478 attendances, 20 845(16.6%) were of patients aged ≥65 years. Multivariate analysis found significant predictors for ED-LOS (C-statistics 0.79, p<0.0000001) to be: arrival mode (ambulance, OR 1.13 (95% CI 1.08 to 1.18)); acuity level (level 4, OR 1.24 (95% CI 1.21 to 1.28); level 1-3, OR 1.54 (95% CI 1.5 to 1.59)); haematological examinations (OR 3.34 (95% CI 3.15 to 3.56)); intravenous treatment (OR 1.58 (95% CI 1.47 to 1.69)); monitoring of vital signs (OR 1.89 (95% CI 1.69 to 2.10)); x-ray examinations (OR 1.53 (95% CI 1.45 to 1.61)); CT/MRI/ultrasound (OR 2.60 (95% CI 2.39 to 2.82)); and specialist advice (OR 1.39 (95% CI 1.30 to 1.48)). For EDOU-LOS (C-statistics 0.81, p<0.0000001) we found: age group (II, OR 1.19 (95% CI 1.16 to 1.22); III, OR 1.42 (95% CI 1.38 to 1.46); IV, OR 1.69 (95% CI 1.65 to 1.74); V, 2.01 (95% CI 1.96 to 2.07)); acuity level (level 4, OR 1.31 (95% CI 1.27 to 1.35); level 1-3, OR 1.71 (95% CI 1.66 to 1.77)); haematological examinations (OR 7.81 (95% CI 7.23 to 8.43)); intravenous treatment (OR 1.95 (95% CI 1.8 to 2.12)); x-ray examinations (OR 1.95 (95% CI 1.85 to 2.06)); CT/MRI/ultrasound (OR 6.74 (95% CI 5.98 to 7.6)); specialist advice (OR 2.24 (95% CI 2.07 to 2.42)); admission to a medical or surgical ward (OR 0.61 (95% CI 0.54 to 0.68)); and transfer (OR 1.79 (95% CI 1.54 to 2.07)). CONCLUSIONS Whereas ED-LOS and EDOU-LOS seem to be directly related to patients' acuity and complexity, notably the need for diagnostic and therapeutic interventions, only EDOU-LOS was significantly associated with age and proposed care pathways. We propose that EDOU-LOS measurement should be made in EDs with an OU.
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Affiliation(s)
| | | | - Anne Peroziello
- Emergency Department, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, Paris, France Medical Information Systems Program (PMSI), University Hospital Bichat-Claude Bernard, Paris, France
| | - Christophe Choquet
- Emergency Department, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, Paris, France Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France
| | - Christophe Leroy
- Emergency Department, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Louis Mourier, Paris, France
| | - Sebastien Beaune
- Emergency Department, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Beaujon, Paris, France
| | | | | | - Jean-Claude Buzzi
- Medical Information Systems Program (PMSI), University Hospital Bichat-Claude Bernard, Paris, France
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