A confidential enquiry into emergency hospital admissions on the Isle of Wight, UK

Hospitalisation Trends for Choroid and Retina Diseases in the Past 20 Years: An Ecological Study in Australia

Background

Choroidal and retinal disorders significantly contribute to vision impairment, often necessitating hospitalization for the purposes of diagnosis, treatment, and continued care. The aim of this study was to examine hospitalisation trends of choroid and retina diseases in the past 20 years in Australia.

Methods

This was an ecological study that used publically available data in Australia from 1998 to 2021. The National Hospital Morbidity Database (NHMD) is an online database that was used to collect the data for this study. We used the chi-squared test to assess the difference between the hospitalisation rates between 1998 and 2021.

Results

During the study period, hospital admission rate for choroid and retina diseases increased by 13.21-fold [from 29.54 (95% CI 28.77-30.32) in 1998 to 419.70 (95% CI 417.21-422.20) in 2021 per 100,000 persons, p<0.001]. Same-day hospital admission patients accounted for 90.3% of the total number of episodes. Rates of same-day hospital admission increased by 37.70-fold [from 9.24 (95% CI 8.81-9.68) in 1998 to 357.78 (95% CI 355.48-360.09) in 2021 per 100,000 persons]. Rates of overnight-stay hospital admission decreased by 19.3% [from 20.34 (95% CI 19.69-20.98) in 1998 to 16.41 (95% CI 15.91-16.90) in 2021 per 100,000 persons]. Females contributed to 54.6% of the total number of hospital admission. Admission rate among females increased by 16.01-fold [from 23.68 (95% CI 22.70-24.66) in 1998 to 402.78 (95% CI 399.33-406.22) in 2021 per 100,000 persons]. Admission rate among males increased by 8.69-fold [from 35.57 (95% CI 34.36-36.78) in 1998 to 344.80 (95% CI 341.58-348.02) in 2021 per 100,000 persons].

Conclusion

In this ecological investigation, we found that the admission rate for choroid and retina disorders increased dramatically. The preponderance of these admissions were made up of females and elderly patients. Future research is required to identify additional risk factors for disorders of this type.

A report on an acute, in-hours, outpatient review clinic with ultrasonography facilities for the early evaluation of general surgical patients

Introduction In 2013 our hospital introduced an in-hours, consultant-led, outpatient acute surgical clinic (ASC) for emergency general surgical patients. In 2014 this clinic was equipped with a dedicated ultrasonography service. This prospective cohort study evaluated this service before and after the introduction of ultrasonography facilities. Methods Data were recorded prospectively for all patients attending the clinic during 2013 and 2014. The primary outcome was patient destination (whether there was follow-up/admission) after clinic attendance. Results The ASC reviewed patients with a wide age range and array of general surgical complaints. In 2013, 186 patients attended the ASC. After the introduction of the ultrasonography service in 2014, 304 patients attended. In 2014, there was a reduction in the proportion of patients admitted to hospital from the clinic (18.3% vs 8.9%, p=0.002). However, the proportion of patients discharged after ASC review remained comparable with 2013 (30.1% in 2013 vs 38.8% in 2014, p=0.051). The proportion of patients undergoing computed tomography (CT) scans also fell (14.0% vs 4.9%, p<0.001). Conclusions The ASC assessed a wide array of general surgical complaints. Only a small proportion required hospital admission. The introduction of an ultrasonography service was associated with a further reduction in admission rates and computed tomography.

EHR in emergency rooms: exploring the effect of key information components on main complaints

This study characterizes the information components associated with improved medical decision-making in the emergency room (ER). We looked at doctors' decisions to use or not to use information available to them on an electronic health record (EHR) and a Health Information Exchange (HIE) network, and tested for associations between their decision and parameters related to healthcare outcomes and processes. Using information components from the EHR and HIE was significantly related to improved quality of healthcare processes. Specifically, it was associated with both a reduction in potentially avoidable admissions as well as a reduction in rapid readmissions. Overall, the three information components; namely, previous encounters, imaging, and lab results emerged as having the strongest relationship with physicians' decisions to admit or discharge. Certain information components, however, presented an association between the diagnosis and the admission decisions (blood pressure was the most strongly associated parameter in cases of chest pain complaints and a previous surgical record for abdominal pain). These findings show that the ability to access patients' medical history and their long term health conditions (via the EHR), including information about medications, diagnoses, recent procedures and laboratory tests is critical to forming an appropriate plan of care and eventually making more accurate admission decisions.

The impact of EHR and HIE on reducing avoidable admissions: controlling main differential diagnoses

BACKGROUND

Many medical organizations have invested heavily in electronic health record (EHR) and health information exchange (HIE) information systems (IS) to improve medical decision-making and increase efficiency. Despite the potential interoperability advantages of such IS, physicians do not always immediately consult electronic health information, and this decision may result in decreased level of quality of care as well as unnecessary costs. This study sought to reveal the effect of EHR IS use on the physicians' admission decisions. It was hypothesizing the using EHR IS will result in more accurate and informed admission decisions, which will manifest through reduction in single-day admissions and in readmissions within seven days.

METHODS

This study used a track log-file analysis of a database containing 281,750 emergency department (ED) referrals in seven main hospitals in Israel. Log-files were generated by the system and provide an objective and unbiased measure of system usage, Thus allowing us to evaluate the contribution of an EHR IS, as well as an HIE network, to decision-makers (physicians). This is done by investigating whether EHR IS lead to improved medical outcomes in the EDs, which are known for their tight time constraints and overcrowding. The impact of EHR IS and HIE network was evaluated by comparing decisions on patients classified by five main differential diagnoses (DDs), made with or without viewing the patients' medical history via the EHR IS.

RESULTS

The results indicate a negative relationship between viewing medical history via EHR systems and the number of possibly redundant admissions. Among the DDs, we found information viewed most impactful for gastroenteritis, abdominal pain, and urinary tract infection in reducing readmissions within seven days, and for gastroenteritis, abdominal pain, and chest pain in reducing the single-day admissions' rate. Both indices are key quality measures in the health system. In addition, we found that interoperability (using external information provided online by health suppliers) contributed more to this reduction than local files, which are available only in the specific hospital. Thus, reducing the rate of redundant admissions by using external information produced larger odds ratios (of the β coefficients; e.g. viewing external information on patients resulted in negative associations of 27.2% regarding readmissions within seven days, and 13% for single-day admissions as compared with viewing local information on patients respectively).

CONCLUSIONS

Viewing medical history via an EHR IS and using HIE network led to a reduction in the number of seven day readmissions and single-day admissions for all patients. Using external medical history may imply a more thorough patient examination that can help eliminate unnecessary admissions. Nevertheless, in most instances physicians did not view medical history at all, probably due to the limited resources available, combined with the stress of rapid turnover in ED units.

Ophthalmic admissions in a tertiary hospital in Nigeria

BACKGROUND

Hospitalization for eye care is required for different reasons. The pattern of admissions into the ophthalmic wards of a sub-urban tertiary hospital was studied.

METHODOLOGY

Records of patients admitted into the Ophthalmology wards of the Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife from January 2004 to December 2007 were reviewed and the age, sex, duration of admission and diagnosis recorded. Data was analyzed with SPSS version 13 and statistical significance inferred at P<0.05.

RESULTS

Of the 523 patients admitted, 60.2% were males while 39.8% were females (P<0.0001); the male preponderance becomes less prominent with increasing age (P=0.001). The duration of admission ranged between 2 and 24 days with a mean of 2.86+/- 1.95 days and 63% were admitted for 3 days. The main indications for admission were cataract (58.3%), ocular trauma (14.3%) and glaucoma (13.4%). Eye injuries were more common among children and young adults while cataract and glaucoma were the leading indications in the middle aged and elderly.

CONCLUSION

Cataract, trauma and glaucoma were the leading indications for ophthalmic hospitalization. Human and infrastructural development of the ophthalmology unit should lay emphasis on the more prevalent needs to enhance effective and efficient management of these diseases.

Use of emergency observation and assessment wards: a systematic literature review

INTRODUCTION

Observation and assessment wards allow patients to be observed on a short-term basis and permit patient monitoring and/or treatment for an initial 24-48 hour period. They should permit concentration of emergency activity and resources in one area, and so improve efficiency and minimise disruption to other hospital services. These types of ward go under a variety of names, including observation, assessment, and admission wards. This review aims to evaluate the current literature and discuss assessment/admission ward functionality in terms of organisation, admission criteria, special patient care, and cost effectiveness.

METHODS

Search of the literature using the Medline and BIDS databases, combined with searches of web based resources. Critical assessment of the literature and the data therein is presented.

RESULTS

The advantages and disadvantages of the use of assessment/admission wards were assessed from the current literature. Most articles suggest that these wards improve patient satisfaction, are safe, decrease the length of stay, provide earlier senior involvement, reduce unnecessary admissions, and may be particularly useful in certain diagnostic groups. A number of studies summarise their organisational structure and have shown that strong management, staffing, organisation, size, and location are important factors for efficient running. There is wide variation in the recommended size of these wards. Observation wards may produce cost savings largely relating to the length of stay in such a unit.

CONCLUSION

All types of assessment/admission wards seem to have advantages over traditional admission to a general hospital ward. A successful ward needs proactive management and organisation, senior staff involvement, and access to diagnostics and is dependent on a clear set of policies in terms of admission and care. Many diagnostic groups benefit from this type of unit, excluding those who will inevitably need longer admission. Vigorous financial studies have yet to be undertaken in the UK. Definitions of observation, assessment, and admission ward are suggested.

Inappropriate admissions: thoughts of patients and referring doctors

Research on inappropriate hospital admissions has tended to neglect the views of the referring doctors and the patients. In this study, the Appropriateness Evaluation Protocol was applied to a random sample of 102 emergency medical admissions. The patients and doctors were then presented with a list of possible alternatives to admission that might have been used at the point of referral. Case notes were available for 88 patients. As judged by these, 28% of admissions were inappropriate, the commonest reason being the potential for treatment or tests to have been performed as outpatient procedures; next commonest was the possibility of lower level care. The response rate to the questionnaires was about two-thirds, for both doctors and patients. Of the general practitioners and casualty doctors who responded, 60% specified alternatives to admission that they would have considered, and the equivalent figure for patients was 70%. For both groups the major preferences were same-day outpatient assessment and admission to a community hospital. Referring doctors and patients, in this survey, favoured alternatives to acute medical care in proportions much higher than that of supposedly inappropriate admission.