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Pope I, Ismail S, Bloom B, Jansen G, Burn H, McCoy D, Harris T. Short-stay admissions at an inner city hospital: a cross-sectional analysis. Emerg Med J 2018; 35:238-246. [PMID: 29305379 DOI: 10.1136/emermed-2016-205803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 11/15/2017] [Accepted: 11/21/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate factors predictive of short hospital admissions and appropriate placement to inpatient versus clinical decision units (CDUs). METHOD This is a retrospective analysis of attendance and discharge data from an inner-city ED in England for December 2013. The primary outcome was admission for less than 48 hours either to an inpatient unit or CDU. Variables included: age, gender, ethnicity, deprivation score, arrival date and time, arrival method, admission outcome and discharge diagnosis. Analysis was performed by cross-tabulation followed by binary logistic regression in three models using the outcome measures above and seeking to identify factors associated with short-stay admission. RESULTS There were 2119 (24%) admissions during the study period and 458 were admitted for less than 24 hours. Those who were admitted in the middle of the week or with ambulatory care sensitive conditions (ACSCs) were significantly more likely to experience short-stays. Older patients and those who arrived by ambulance were significantly more likely to have a longer hospital stay. There was no association of length of inpatient stay with being admitted in the last 10 min of a 4 hours ED stay. CONCLUSION Only a few factors were independently predictive of short stays. Patients with ACSCs were more likely to have short stays, regardless of whether they were admitted to CDU or an inpatient ward. This may be a group of patients that could be targeted for dedicated outpatient management pathways or CDU if they need admission.
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Affiliation(s)
- Ian Pope
- Department of Emergency Medicine, Royal London Hospital, London, UK
| | - Sharif Ismail
- Department of Emergency Medicine, Royal London Hospital, London, UK
| | - Benjamin Bloom
- Department of Emergency Medicine, Royal London Hospital, London, UK
| | - Gwyneth Jansen
- School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Helen Burn
- Department of Emergency Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - David McCoy
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Tim Harris
- Department of Emergency Medicine, Royal London Hospital, London, UK
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Dawes TR, Cheek E, Bewick V, Dennis M, Duckitt RW, Walker J, Forni LG, Venn R. Introduction of an electronic physiological early warning system: effects on mortality and length of stay. Br J Anaesth 2014; 113:603-9. [PMID: 24878563 DOI: 10.1093/bja/aeu107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Worthing physiological scoring system (PSS) was first validated in 2005 as a tool to predict hospital mortality on admission and was subsequently introduced into clinical practice at Worthing Hospital, UK. Five years on, this study was conducted to determine the effects on mortality and length of stay (LOS) after the introduction of electronic alerting software using the PSS. In addition, we investigated whether the Worthing PSS predictive ability could be improved by addition of further variables. METHODS Prospective observational study conducted in the acute medical unit, Worthing Hospital, UK. Patient physiological data on admission and discharge/transfer were collected between February and July 2010 from the electronic alerting software VitalPAC™. Patient characteristics, co-morbidity, outcomes, and biochemistry data were taken from the hospital administration and pathology systems. RESULTS The observed mortality reduction from 8.3% to 5.2% over 5 yr was not statistically significant after adjustment for admission Worthing PSS score. Median LOS was reduced from 4 to 2 days, but this reflected an increase in short stay admissions. Worthing PSS was not significantly improved with the addition of biochemical variables or patient co-morbidity. A score taken before admission to a medical ward showed an improved predictive ability when compared with the initial admission score, but further analysis found no additional clinical benefit. CONCLUSIONS The introduction of an electronic alerting PSS did not lead to a reduction in mortality when adjusted for severity of illness defined by physiological variables. Predictive performance was not enhanced by the addition of biochemical variables and co-morbidities.
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Affiliation(s)
- T R Dawes
- Intensive Care Unit, Worthing Hospital, Lyndhurst Road, Worthing BN11 2DH, UK
| | - E Cheek
- School of Computing, Mathematical and Information Sciences, University of Brighton, Brighton BN2 4AT, UK
| | - V Bewick
- School of Computing, Mathematical and Information Sciences, University of Brighton, Brighton BN2 4AT, UK
| | - M Dennis
- Department of Performance and Information, Worthing Hospital, Lyndhurst Road, Worthing BN11 2DH, UK
| | - R W Duckitt
- Acute Medical Unit, Worthing Hospital, Lyndhurst Road, Worthing BN11 2DH, UK
| | - J Walker
- Acute Medical Unit, Worthing Hospital, Lyndhurst Road, Worthing BN11 2DH, UK
| | - L G Forni
- Intensive Care Unit, Worthing Hospital, Lyndhurst Road, Worthing BN11 2DH, UK
| | - R Venn
- Intensive Care Unit, Worthing Hospital, Lyndhurst Road, Worthing BN11 2DH, UK
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Jones P, Chalmers L, Wells S, Ameratunga S, Carswell P, Ashton T, Curtis E, Reid P, Stewart J, Harper A, Tenbensel T. Implementing performance improvement in New Zealand emergency departments: the six hour time target policy national research project protocol. BMC Health Serv Res 2012; 12:45. [PMID: 22353694 PMCID: PMC3311075 DOI: 10.1186/1472-6963-12-45] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 02/21/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In May 2009, the New Zealand government announced a new policy aimed at improving the quality of Emergency Department care and whole hospital performance. Governments have increasingly looked to time targets as a mechanism for improving hospital performance and from a whole system perspective, using the Emergency Department waiting time as a performance measure has the potential to see improvements in the wider health system. However, the imposition of targets may have significant adverse consequences. There is little empirical work examining how the performance of the wider hospital system is affected by such a target. This project aims to answer the following questions: How has the introduction of the target affected broader hospital performance over time, and what accounts for these changes? Which initiatives and strategies have been successful in moving hospitals towards the target without compromising the quality of other care processes and patient outcomes? Is there a difference in outcomes between different ethnic and age groups? Which initiatives and strategies have the greatest potential to be transferred across organisational contexts? METHODS/DESIGN The study design is mixed methods; combining qualitative research into the behaviour and practices of specific case study hospitals with quantitative data on clinical outcomes and process measures of performance over the period 2006-2012. All research activity is guided by a Kaupapa Māori Research methodological approach. A dynamic systems model of acute patient flows was created to frame the study. Consequences of the target (positive and negative) will be explored by integrating analyses and insights gained from the quantitative and qualitative streams of the study. DISCUSSION At the time of submission of this protocol, the project has been underway for 12 months. This time was necessary to finalise both the case study sites and the secondary outcomes through key stakeholder consultation. We believe that this is an appropriate juncture to publish the protocol, now that the sites and final outcomes to be measured have been determined.
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Affiliation(s)
- Peter Jones
- Adult Emergency Department, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand
- Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Linda Chalmers
- Health Systems, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Susan Wells
- Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Shanthi Ameratunga
- Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Peter Carswell
- Health Systems, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Toni Ashton
- Health Systems, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Elana Curtis
- Te Kupenga Hauora Māori, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Papaarangi Reid
- Te Kupenga Hauora Māori, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joanna Stewart
- Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Alana Harper
- Adult Emergency Department, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand
| | - Tim Tenbensel
- Health Systems, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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