scholarly journals Sex, age and socioeconomic inequalities in older people’s unscheduled care

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
K Levin ◽  
E Crighton
Keyword(s):  
Length Of Stay ◽  
Emergency Services ◽  
Time Of Day ◽  
Socioeconomic Inequalities ◽  
Population Projections ◽  
Interaction Terms ◽  
Unscheduled Care ◽  
Accident And Emergency ◽  
Care Patterns ◽  
Poisson Modelling

Abstract Background In Scotland, unscheduled care is usually received at hospital accident and emergency (A&E) departments or referral by GPs to medical assessment units (MAU). Almost a quarter attendances are for those aged 65 years+. Demand for unscheduled care will increase as the population ages. This study measures inequalities in unscheduled care presentations among those aged 65 years+. Methods A&E and MAU attendance data between April 2017 and March 2018 for Glasgow residents were analysed. Data were modelled using poisson modelling for outcome measures attendances, rate of attendance and length of stay, adjusting for agegroup, sex and deprivation. A second set of models also adjusted for time of day, month and referral source, including interaction terms. Results While there was a higher number of attendances among females (RR and 95% CI = 0.30 (0.28, 0.32)), and among those aged 65-69 years compared with older ages (RR = 0.03 (0.01, 0.06)), modelling rates showed that males were significantly more likely to attend (RR = 0.14 (0.13, 0.16)) and that likelihood rose with age, eg RR for 85+ years significantly greater than 80-84 years, significantly greater than for 75-79 years etc. There was no gender difference in length of stay but this increased with increasing age. Attendance was significantly more likely for those living in the most deprived quintile of deprivation (RR = 0.30 (0.27, 0.34) compared with the most affluent quintile). SES inequalities in attendance and length of stay became less pronounced with increasing age. Referrals via 999 emergency services increased with age while referrals by GP and NHS24 reduced with age. Attendance was more likely in December (RR = 0.15 (0.11, 0.18)) and likelihood of a morning attendance reduced significantly with increasing age and deprivation. Conclusions Inequalities in attendance, length of stay and methods of referral are observed which should be considered when planning to meet the demand for unscheduled care. Key messages Age, sex and socioeconomic inequalities in unscheduled care exist even at the oldest ages. When planning to meet the demand of future unscheduled care, patterns of current use and population projections should be considered in tandem.

Prioritization and management of calls from older people to GP out-of-hours services

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Suzanne Smith ◽  
Lucia Carragher
Keyword(s):  
Older People ◽  
Service Provision ◽  
Emergency Services ◽  
Oldest Old ◽  
Community Dwelling ◽  
Third Party ◽  
Older Person ◽  
Out Of Hours ◽  
Accident And Emergency ◽  
Community Dwelling Older People

Abstract Background Urgent out-of-hours medical care is necessary to ensure people can remain living at home into older age. However, older people experience multiple barriers to using out-of-hours services including poor awareness about the general practitioner (GP) out-of-hours (GPOOH) service and how to access it. In particular, older people are reluctant users of GPOOH services because they expect either their symptoms will not be taken seriously or they will simply be referred to hospital accident and emergency services. The aim of this study was to examine if this expectation was borne out in the manner of GPOOH service provision. Objective The objective was to establish the urgency categorization and management of calls to GPOOH , for community dwelling older people in Ireland. Methods An 8-week sample of 770 calls, for people over 65 years, to a GPOOH service in Ireland, was analysed using Excel and Nvivo software. Results Urgency categorization of older people shows 40% of calls categorized as urgent. Recognition of the severity of symptoms, prompting calls to the GPOOH service, is also reflected in a quarter of callers receiving a home visit by the GP and referral of a third of calls to emergency services. The findings also show widespread reliance on another person to negotiate the GPOOH system, with a third party making 70% of calls on behalf of the older person seeking care. Conclusion Older people are in urgent need of medical services when they contact GPOOH service, which plays an effective and patient-centred gatekeeping role, particularly directing the oldest old to the appropriate level of care outside GP office hours. The promotion of GPOOH services should be enhanced to ensure older people understand their role in supporting community living.

scholarly journals Accident and emergency services.

BMJ ◽  
1991 ◽  
Vol 302 (6774) ◽  
pp. 470-471 ◽  
Author(s):  
D V Skinner
Keyword(s):  
Emergency Services ◽  
Accident And Emergency

scholarly journals Robust capacity planning for accident and emergency services

2020 ◽  
Vol 54 (6) ◽  
pp. 1757-1773
Author(s):  
Elvan Gökalp
Keyword(s):  
Capacity Planning ◽  
Emergency Services ◽  
Simulation Optimization ◽  
Patient Flow ◽  
Waiting Times ◽  
Model Parameters ◽  
Planning Problem ◽  
Accident And Emergency ◽  
Number Of Patients ◽  
The Impact

Accident and emergency departments (A&E) are the first place of contact for urgent and complex patients. These departments are subject to uncertainties due to the unplanned patient arrivals. After arrival to an A&E, patients are categorized by a triage nurse based on the urgency. The performance of an A&E is measured based on the number of patients waiting for more than a certain time to be treated. Due to the uncertainties affecting the patient flow, finding the optimum staff capacities while ensuring the performance targets is a complex problem. This paper proposes a robust-optimization based approximation for the patient waiting times in an A&E. We also develop a simulation optimization heuristic to solve this capacity planning problem. The performance of the approximation approach is then compared with that of the simulation optimization heuristic. Finally, the impact of model parameters on the performances of two approaches is investigated. The experiments show that the proposed approximation results in good enough solutions.

Association of Length of Stay at Emergency Services in the Outcome of Admitted Patients

2019 ◽  
Author(s):  
RP Neupane ◽  
S Raut ◽  
TM Shrestha ◽  
R Aacharya
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Emergency Services ◽  
Unit Length ◽  
University Teaching ◽  
Cross Sectional ◽  
Prolonged Stay ◽  
Icu Outcome ◽  
Ultimate Outcome

Abstract Background: Access block and overcrowding leading to prolonged stay in emergency room is a common problem of Emergency services of Tribhuvan University Teaching Hospital (TUTH) Kathmandu. Those patients who stayed longer in emergency department might affect continuing care and the ultimate outcome of patients. Study aims to evaluate the association of emergency services length of stay and outcome of admitted patients in wards or Intensive Care Unit at the predefined cut-off value of 6 hour. Methods: It was a prospective cross sectional comparative study done in TUTH, Kathmandu. Data were collected from records from emergency services, wards, ICU and hospital record section from October, 2018 to April, 2019. Adult patients were grouped in to two groups; Emergency services to wards (ES to Wards) and Emergency services to ICU (ES to ICU). Outcome was compared between those admitted within 6hr and those admitted after 6hr of stay in emergency services. Results: A total of 2,059 patients were enrolled over 6 months. Out of them, Male were 55.5% and 42.6% patients were at the age of equal to or above 60 years. Total admitted patients who stayed equal to or less than 6 hr in emergency services was 26.7%. It was found that there was no significant association between Emergency services length of stay (ESLOS) and outcome of admitted total patients (p= 0.160) as well as in ICU (p= 0.559) or Ward admitted patients (p= 0.361). Age was found independent predictor for outcome (p= <0.01). Association of ESLOS and age was also found statistically significant (p= 0.02). Conclusions: Emergency service length of stay is not predictor for outcome of admitted patients. Key words: Emergency services, intensive care unit, length of stay, mortality.

scholarly journals Employment of Emergency Advanced Nurses of Turkey: A Discrete-Event Simulation Application

Processes ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 48 ◽  
Author(s):  
Abdulkadir Atalan ◽  
Cem Donmez
Keyword(s):  
Length Of Stay ◽  
Discrete Event Simulation ◽  
Emergency Services ◽  
Treatment Time ◽  
Waiting Times ◽  
Discrete Event ◽  
Weekly Basis ◽  
Event Simulation ◽  
Number Of Patients ◽  
Efficiency Rate

In the present study, problems in emergency services (ESs) were dealt with by analyzing the working system of ESs in Turkey. The purpose of this study was to reduce the waiting times spent in hospitals by employing advanced nurses (ANs) to treat patients who are not urgent, or who may be treated as outpatients in ESs. By applying discrete-event simulation on a 1/24 (daily) and 7/24 (weekly) basis, and by employing ANs, it was determined that the number of patients that were treated increased by 26.71% on a 1/24 basis, and by 15.13% on a 7/24 basis. The waiting time that was spent from the admission to the ES until the treatment time decreased by 38.67% on a 1/24 basis and 53.66% on a 24/7 basis. Similarly, the length of stay was reduced from 82.46 min to 53.97 min in the ES. Among the findings, it was observed that the efficiency rate of the resources was balanced by the employment of ANs, although it was not possible to obtain sufficient efficiency from the resources used in the ESs prior to the present study.

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