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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

Standardised admissions ratio: Emergency Assessment Unit model versus similarhospitals.
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fig3: Standardised admissions ratio: Emergency Assessment Unit model versus similarhospitals.

Mentions: The SAR decreased suddenly in 2006 when the EAU opened and was the lowest of all thehospitals in the sample in 2006, 2007, 2008 and 2009 (table 2). The probability one prespecified hospital out of 16 performsconsistently best across all 4 years is highly statistically significant, withp=0.0002 (figure 3).


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)

Standardised admissions ratio: Emergency Assessment Unit model versus similarhospitals.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig3: Standardised admissions ratio: Emergency Assessment Unit model versus similarhospitals.
Mentions: The SAR decreased suddenly in 2006 when the EAU opened and was the lowest of all thehospitals in the sample in 2006, 2007, 2008 and 2009 (table 2). The probability one prespecified hospital out of 16 performsconsistently best across all 4 years is highly statistically significant, withp=0.0002 (figure 3).

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