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Reductions in hospital admissions and mortality rates observed after integrating emergency care: a natural experiment.

Boyle AA, Ahmed V, Palmer CR, Bennett TJ, Robinson SM - BMJ Open (2012)

Bottom Line: The authors evaluated changes in admissions and mortality before and after 2006, compared with other similar hospitals.The authors observed a statistically and clinically significant decrease in HSMR and SAR.This was statistically significant, p=0.0149 and p=0.0002, respectively.

View Article: PubMed Central - PubMed

Affiliation: Emergency Department, Cambridge University Foundation Hospitals NHS Trust, Cambridge, UK.

ABSTRACT

Objectives: Reducing emergency admissions is a priority for the NHS. A single hospital's emergency care system was reorganised with the principles of front-loaded investigations, integration of specialties, reduced duplication, earlier decision making by senior clinicians and a combined emergency assessment area. The authors relocated our Medical Assessment Unit into our emergency department in 2006. The authors evaluated changes in admissions and mortality before and after 2006, compared with other similar hospitals.

Design: Quasi-experimental before and after study using routinely collected data.

Setting and participants: 1 acute hospital in England, the intervention site, was compared with 23 other English hospitals between 2001 and 2009.

Outcome measures: Our outcome measures were hospital standardised mortality ratios (HSMRs) for non-elective admissions and standardised admission ratios (SARs).

Results: The authors observed a statistically and clinically significant decrease in HSMR and SAR. The intervention hospital had the lowest HSMR and SAR of all the hospitals in our sample. This was statistically significant, p=0.0149 and p=0.0002, respectively.

Conclusion: Integrating emergency care in one location is associated with a meaningful reduction in mortality and emergency admissions to hospital.

No MeSH data available.


Related in: MedlinePlus

Traditional process for evaluating patients presenting for unscheduled care before2006. ED, Emergency Department; MAU, Medical Admissions Unit.
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fig1: Traditional process for evaluating patients presenting for unscheduled care before2006. ED, Emergency Department; MAU, Medical Admissions Unit.

Mentions: We opened the Emergency Assessment Unit (EAU) in 2006. The two diagrams show the processfor admitting or discharging the majority of emergency patients presenting to ourhospital. This was broadly similar to admission process in most acute hospitals in theUK before 2006 and radically different afterwards. We redesigned the service, so thatthe majority of non-elective admissions attended the emergency department. In 2006, weclosed our MAU and relocated the staff to the emergency department. We expanded theemergency department by about the number of beds that the MAU had had. We developed acombined clerking process that was supported by shared documentation, with the overallaim of reducing assessments (figures 1 and 2). The emergency department was supported by thedevelopment of the short stay medical and surgical wards, a clinical decisions unit anda children's observation unit. These wards aimed to look after patients for nomore than 3 days. There was an increased access to emergency radiology. Theproportion of non-elective admissions entering the hospital through the emergencydepartment rose from about 50% to around 80%. Patients requiring admission from theoutpatient department, referrals from other hospitals and obstetric patients continuedto bypass the emergency department. We did not use an explicit theoretical or scientificframework to guide us, but our approach had elements of lean manufacturing techniques inthat we performed value stream mapping of patient pathways.4 Our approach differed from ‘lean’ in that there was a‘big bang launch’, and there was less emphasis on continuous improvementin this program than a ‘lean model’.


Reductions in hospital admissions and mortality rates observed after integrating emergency care: a natural experiment.

Boyle AA, Ahmed V, Palmer CR, Bennett TJ, Robinson SM - BMJ Open (2012)

Traditional process for evaluating patients presenting for unscheduled care before2006. ED, Emergency Department; MAU, Medical Admissions Unit.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4400673&req=5

fig1: Traditional process for evaluating patients presenting for unscheduled care before2006. ED, Emergency Department; MAU, Medical Admissions Unit.
Mentions: We opened the Emergency Assessment Unit (EAU) in 2006. The two diagrams show the processfor admitting or discharging the majority of emergency patients presenting to ourhospital. This was broadly similar to admission process in most acute hospitals in theUK before 2006 and radically different afterwards. We redesigned the service, so thatthe majority of non-elective admissions attended the emergency department. In 2006, weclosed our MAU and relocated the staff to the emergency department. We expanded theemergency department by about the number of beds that the MAU had had. We developed acombined clerking process that was supported by shared documentation, with the overallaim of reducing assessments (figures 1 and 2). The emergency department was supported by thedevelopment of the short stay medical and surgical wards, a clinical decisions unit anda children's observation unit. These wards aimed to look after patients for nomore than 3 days. There was an increased access to emergency radiology. Theproportion of non-elective admissions entering the hospital through the emergencydepartment rose from about 50% to around 80%. Patients requiring admission from theoutpatient department, referrals from other hospitals and obstetric patients continuedto bypass the emergency department. We did not use an explicit theoretical or scientificframework to guide us, but our approach had elements of lean manufacturing techniques inthat we performed value stream mapping of patient pathways.4 Our approach differed from ‘lean’ in that there was a‘big bang launch’, and there was less emphasis on continuous improvementin this program than a ‘lean model’.

Bottom Line: The authors evaluated changes in admissions and mortality before and after 2006, compared with other similar hospitals.The authors observed a statistically and clinically significant decrease in HSMR and SAR.This was statistically significant, p=0.0149 and p=0.0002, respectively.

View Article: PubMed Central - PubMed

Affiliation: Emergency Department, Cambridge University Foundation Hospitals NHS Trust, Cambridge, UK.

ABSTRACT

Objectives: Reducing emergency admissions is a priority for the NHS. A single hospital's emergency care system was reorganised with the principles of front-loaded investigations, integration of specialties, reduced duplication, earlier decision making by senior clinicians and a combined emergency assessment area. The authors relocated our Medical Assessment Unit into our emergency department in 2006. The authors evaluated changes in admissions and mortality before and after 2006, compared with other similar hospitals.

Design: Quasi-experimental before and after study using routinely collected data.

Setting and participants: 1 acute hospital in England, the intervention site, was compared with 23 other English hospitals between 2001 and 2009.

Outcome measures: Our outcome measures were hospital standardised mortality ratios (HSMRs) for non-elective admissions and standardised admission ratios (SARs).

Results: The authors observed a statistically and clinically significant decrease in HSMR and SAR. The intervention hospital had the lowest HSMR and SAR of all the hospitals in our sample. This was statistically significant, p=0.0149 and p=0.0002, respectively.

Conclusion: Integrating emergency care in one location is associated with a meaningful reduction in mortality and emergency admissions to hospital.

No MeSH data available.


Related in: MedlinePlus