scholarly journals The association between opening a short stay paediatric assessment unit and trends in short stay hospital admissions

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Steve Turner ◽  
Edwin-Amalraj Raja
Keyword(s):  
Hospital Admissions ◽  
Geographic Region ◽  
Health Board ◽  
Short Stay ◽  
Emergency Admissions ◽  
Inpatient Ward ◽  
Assessment Unit ◽  
Stay Hospital ◽  
Clinical Referral ◽  
Health Boards

Abstract Background Many inpatient facilities in Scotland have opened short stay paediatric assessment units (SSPAU) which are clinical areas separate from the usual inpatient ward area and these are where most short stay (also called zero day) admissions are accommodated. Here we describe the effect of opening short stay paediatric assessment units (SSPAU) on the proportion of zero day admissions relative to all emergency admissions. Methods Details of all emergency medical paediatric admissions to Scottish hospitals between 2000 and 2013 were obtained, including the number of zero day admissions per month and health board (i.e. geographic region). The month and year that an SSPAU opened in each health board was provided by local clinicians. Results SSPAUs opened in 7 health boards, between 2004 and 2012. Health boards with an SSPAU had a slower rise in zero day admissions compared to those without SSPAU (0.6% per month [95% CI 0.04, 0.09]. Across all 7 health boards, opening an SSPAU was associated with a 13% [95% CI 10, 15] increase in the proportion of zero day admissions. When considered individually, zero day admissions rose in four health boards after their SSPAU opened, were unchanged in one and fell in two health boards. Independent of SSPAUs opening, there was an increase in the proportion of all admissions which were zero day admissions (0.1% per month), and this accelerated after SSPAUs opened. Conclusion Opening an SSPAU has heterogeneous outcomes on the proportion of zero day admissions in different settings. Zero day admissions could be reduced in some health boards by understanding differences in clinical referral pathways between health boards with contrasting trends in zero day admissions after their SSPAU opens.

scholarly journals The association between opening a short stay paediatric assessment unit and trends in short stay hospital admissions

2020 ◽  
Author(s):  
Steve Turner ◽  
Edwin Raja
Keyword(s):  
Hospital Admissions ◽  
Geographic Region ◽  
Health Board ◽  
Short Stay ◽  
Emergency Admissions ◽  
Paediatric Hospital ◽  
Inpatient Ward ◽  
Assessment Unit ◽  
Stay Hospital ◽  
Health Boards

Abstract Background. Rising acute paediatric hospital admissions in Scotland are explained by rising numbers of admissions lasting less than 24 hours (zero day admissions). Many inpatient facilities in Scotland have opened short stay paediatric assessment units (SSPAU) which are clinical areas separate from the usual inpatient ward area and these are where most zero day admissions are accommodated. Here we describe the effect of opening short stay paediatric assessment units (SSPAU) on the proportion of zero day admissions relative to all emergency admissions.Methods. Details of all emergency medical paediatric admissions to Scottish hospitals between 2000 and 2013 were obtained, including the number of zero day admissions per month and health board (i.e. geographic region). The month and year that an SSPAU opened in each health board was provided by local clinicians.Results. SSPAUs opened in 7 health boards, between 2004 and 2012. The rise in zero day admissions was greater in health boards with no SSPAU compared to those with an SSPAU. Across all 7 health boards, opening an SSPAU was associated with a 13% [95% CI 10, 15] increase in the proportion of zero day admissions. When considered individually, zero day admissions rose in four health boards after their SSPAU opened, were unchanged in one and fell in two health boards. Independent of SSPAUs opening, there was an increase in the proportion of all admissions which were zero day admissions (0.1% per month), and this accelerated after SSPAUs opened.Conclusion. Opening an SSPAU may increase in the proportion of zero day admissions, but in some settings may reduce this proportion. Zero day admissions could be reduced in some health boards by understanding differences in clinical referral pathways between health boards with contrasting trends in zero day admissions after their SSPAU opens.

scholarly journals P81 The efficacy of a nurse led, primary care, acute asthma service in reducing short stay hospital admissions

Thorax ◽  
2011 ◽  
Vol 66 (Suppl 4) ◽  
pp. A101-A101
Author(s):  
G. J. Connett ◽  
P. Lovegrove ◽  
S. Lovick ◽  
J. P. Legg
Keyword(s):  
Primary Care ◽  
Hospital Admissions ◽  
Acute Asthma ◽  
Short Stay ◽  
Stay Hospital

Short-stay admissions at an inner city hospital: a cross-sectional analysis

2018 ◽  
Vol 35 (4) ◽  
pp. 238-246
Author(s):  
Ian Pope ◽  
Sharif Ismail ◽  
Benjamin Bloom ◽  
Gwyneth Jansen ◽  
Helen Burn ◽  
...  
Keyword(s):  
Inner City ◽  
Hospital Admissions ◽  
Binary Logistic Regression ◽  
Clinical Decision ◽  
City Hospital ◽  
Short Stay ◽  
Cross Sectional ◽  
Discharge Data ◽  
Inpatient Ward ◽  
Sectional Analysis

ObjectiveTo investigate factors predictive of short hospital admissions and appropriate placement to inpatient versus clinical decision units (CDUs).MethodThis 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.ResultsThere 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.ConclusionOnly 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.

scholarly journals Effects of Medicare Medical Reviews on Ambiguous Short‐Stay Hospital Admissions

2018 ◽  
Vol 53 (6) ◽  
pp. 4747-4766 ◽  
Author(s):  
Benjamin C. Silver ◽  
Momotazur Rahman ◽  
Brad Wright ◽  
Richard Besdine ◽  
Pedro Gozalo ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Short Stay ◽  
Stay Hospital

The outcomes of emergency hospital admissions with non-malignant upper gastrointestinal bleeding in England between 2003 and 2015

Endoscopy ◽  
2021 ◽  
Author(s):  
James Rees ◽  
Felicity Evison ◽  
Jemma Mytton ◽  
Prashant Patel ◽  
Nigel Trudgill
Keyword(s):  
Gastrointestinal Bleeding ◽  
Variceal Bleeding ◽  
Key Management ◽  
Hospital Admissions ◽  
Upper Gastrointestinal Bleeding ◽  
Medical Emergency ◽  
Emergency Admissions ◽  
Co Morbidity ◽  
Standardized Mortality Rate ◽  
Upper Gastrointestinal

Abstract Background Upper gastrointestinal bleeding (UGIB) is a common medical emergency with significant mortality. Despite developments in endoscopic and clinical management, only minor improvements in outcomes have been reported. Methods This was a retrospective cohort study of patients with non-malignant UGIB emergency admissions in England between 2003 and 2015, using Hospital Episode Statistics. Multilevel logistic regression analysis examined the associations with mortality. Results 242 796 patients with an UGIB admission were identified (58.8 % men; median age 70 [interquartile range (IQR) 53 – 81]). Between 2003 and 2015, falls occurred in both 30-day mortality (7.5 % to 7.0 %; P < 0.001) and age-standardized mortality (odds ratio (OR) 0.74, 95 % confidence interval [CI] 0.69 – 0.80; P < 0.001), including from variceal bleeding (OR 0.63, 95 %CI 0.45 – 0.87; P < 0.005). Increasing co-morbidity (Charlson score > 5, OR 2.94, 95 %CI 2.85 – 3.04; P < 0.001), older age (> 83 years, OR 6.50, 95 %CI 6.09 – 6.94; P < 0.001), variceal bleeding (OR 2.03, 95 %CI 1.89 – 2.18; P < 0.001), and a weekend admission (Sunday, OR 1.18, 95 %CI 1.12 – 1.23; P < 0.001) were associated with 30-day mortality. Of deaths at 30 days, 8.9 % were from ischemic heart disease (IHD) and the cardiovascular age-standardized mortality rate following UGIB was high (IHD deaths within 1 year, 1188.4 [95 %CI 1036.8 – 1353.8] per 100 000 men in 2003). Conclusions Between 2003 and 2015, 30-day mortality among emergency admissions with non-malignant UGIB fell by 0.5 % to 7.0 %. Mortality was higher among UGIB admissions at the weekend, with important implications for service provision. Patients with UGIB had a much greater risk of subsequently dying from cardiovascular disease and addressing this risk is a key management step in UGIB.

scholarly journals Comparative 4-year risk and type of hospital admission among homeless and housed emergency department attendees: longitudinal study of hospital records in England 2013–2018

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e049811
Author(s):  
Charlie Moss ◽  
Matt Sutton ◽  
Sudeh Cheraghi-Sohi ◽  
Caroline Sanders ◽  
Thomas Allen
Keyword(s):  
Emergency Department ◽  
Hospital Admissions ◽  
Primary Diagnosis ◽  
Secondary Outcome ◽  
Emergency Admissions ◽  
Incident Rate Ratio ◽  
Chronic Angina ◽  
Access To Primary Care ◽  
Incident Rate ◽  
Preventable Admissions

ObjectivesPeople experiencing homelessness are frequent users of secondary care. Currently, there is no study of potentially preventable admissions for homeless patients in England. We aim to estimate the number of potentially preventable hospital admissions for homeless patients and compare to housed patients with similar characteristics.DesignRetrospective matched cohort study.SettingHospitals in England.Participants16 161 homeless patients and 74 780 housed patients aged 16–75 years who attended an emergency department (ED) in England in 2013/2014, matched on the basis of age, sex, ED attended and primary diagnosis.Primary and secondary outcome measuresAnnual counts of admissions, emergency admissions, ambulatory care-sensitive (ACS) emergency admissions, acute ACS emergency admissions and chronic ACS emergency admissions over the following 4 years (2014/2015–2017/2018). We additionally compare the prevalence of specific ACS conditions for homeless and housed patients.ResultsMean admissions per 1000 patients per year were 470 for homeless patients and 230 for housed patients. Adjusted for confounders, annual admissions were 1.79 times higher (incident rate ratio (IRR)=1.79; 95% CI 1.69 to 1.90), emergency admissions 2.08 times higher (IRR=2.08; 95% CI 1.95 to 2.21) and ACS admissions 1.65 times higher (IRR=1.65; 95% CI 1.51 to 1.80), compared with housed patients. The effect was greater for acute (IRR=1.78; 95% CI 1.64 to 1.93) than chronic (IRR=1.45; 95% CI 1.27 to 1.66) ACS conditions. ACS conditions that were relatively more common for homeless patients were cellulitis, convulsions/epilepsy and chronic angina.ConclusionsHomeless patients use hospital services at higher rates than housed patients, particularly emergency admissions. ACS admissions of homeless patients are higher which suggests some admissions may be potentially preventable with improved access to primary care. However, these admissions comprise a small share of total admissions.

Incorporating gout guideline advice into urate reports is associated with reduced hospital admissions: results of an observational study

Rheumatology ◽  
2021 ◽  
Author(s):  
Philip L Riches ◽  
Laura Downie ◽  
Carol Thomson
Keyword(s):  
Hospital Admissions ◽  
Relative Rate ◽  
Primary Diagnosis ◽  
Relative Increase ◽  
Local Data ◽  
Improved Outcomes ◽  
Significant Difference ◽  
Prescription Rates ◽  
The Impact ◽  
Health Boards

Abstract Objective To evaluate the impact of incorporating treatment guidance into reporting of urate test results. Methods Urate targets for clinically confirmed gout were added to urate results above 0.36 mmol/l requested after September 2014 within NHS Lothian. Scotland-wide data on urate-lowering therapy prescriptions and hospital admissions with gout were analysed between 2009 and 2020. Local data on urate tests were analysed between 2014 and 2015. Results Admissions with a primary diagnosis of gout in Lothian reduced modestly following the intervention from 111/year in 2010–2014 to 104/year in 2015–2019, a non-significant difference (P = 0.32). In contrast there was a significant increase in admissions to remaining NHS Scotland health boards (556/year vs 606/year, P &lt; 0.01). For a secondary diagnosis of gout the number of admissions in NHS Lothian reduced significantly (58/year vs 39/year, P &lt; 0.01) contrasting with a significant increase in remaining Scottish health boards (220/year vs 290/year, P &lt; 0.01). The relative rate of admissions to NHS Lothian compared with remaining Scottish boards using a 2009 baseline were significantly reduced for both primary diagnosis of gout (1.06 vs 1.25, P &lt; 0.001) and secondary diagnoses of gout (0.64 compared with 1.4, P &lt; 0.001) after the intervention; however, there was no difference before the intervention. A relative increase in the prescription rates of allopurinol 300 mg tablets and febuxostat 120 mg tablets may have contributed to the improved outcomes seen. Conclusion Incorporation of clinical guideline advice into routine reporting of urate results was associated with reduced rates of admission with gout in NHS Lothian, in comparison with other Scottish health boards.

Development of a paediatric short-stay observation and assessment unit

2018 ◽  
Vol 30 (3) ◽  
pp. 20-25
Author(s):  
Tracey Jones ◽  
Helen Russell-Fisher
Keyword(s):  
Short Stay ◽  
Assessment Unit

scholarly journals Enhancing Chemotherapy Capabilities in Rural Hospitals: Implementation of a Telechemotherapy Model (QReCS) in North Queensland, Australia

2018 ◽  
Vol 14 (7) ◽  
pp. e429-e437 ◽  
Author(s):  
Sabe Sabesan ◽  
Clare Senko ◽  
Andrew Schmidt ◽  
Abhishek Joshi ◽  
Ritwik Pandey ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Descriptive Analysis ◽  
Geographic Region ◽  
Treatment Delays ◽  
Face To Face ◽  
Implementation Processes ◽  
Queensland Health ◽  
Medium Risk ◽  
Rural Sites ◽  
Cancer Networks

Introduction: The Queensland Remote Chemotherapy Supervision (QReCS) model enables rural nurses to administer chemotherapy in smaller rural towns under supervision by health professionals from larger centers using telehealth. Its implementation began in North Queensland, Australia (population, 650,000), in 2014 between two regional cancer centers (Townsville and Cairns as primary sites) and six rural sites (125 to 1,000 kilometers from primary sites). Our study examined the implementation processes, feasibility, and safety of this model. Methods: Details of implementation and patients’ clinical details for the period of 2014 to 2016 for descriptive analysis were extracted from telechemotherapy project notes and oncology information systems of North Queensland, respectively. Results: After a successful pilot study in Townsville Cancer Centre, statewide rural and cancer networks of Queensland Health, in collaboration with clinicians and managers across the state of Queensland, developed the QReCS model and a guide for operationalizing it. QReCS was implemented at six sites from 2014 to 2016. Main enablers across North Queensland included collaboration among clinicians and managers, availability of common electronic medical records, funding from Queensland Health, and installation of telehealth infrastructure by statewide telehealth services. Main barriers included turnover of senior management and nursing staff at two rural towns. Sixty-two patients received 327 cycles of low- to medium-risk chemotherapy agents. Rates of treatment delays, adverse events, and hospital admissions were similar to those in face-to-face care. Conclusion: Implementation of the QReCS model across a large geographic region is feasible with acceptable safety profiles. Leadership by and collaboration among clinicians and managers, adequacy of resources and common governance are key enablers.

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