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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

HSMR for non-elective admissions: Emergency Assessment Unit model compared toother similar hospitals.
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fig4: HSMR for non-elective admissions: Emergency Assessment Unit model compared toother similar hospitals.

Mentions: There was a steady decrease in our HSMR, compared with controls during the study period(table 1). This decrease began in 2003. Thiswas maintained and was the lowest of all the hospitals in the study in 2007, 2008 and2009. The probability that the intervention hospital performed best out of 16 hospitaltrusts 3 out of 4 years is statistically significant, p=0.0149 (figure 4). We adjusted both SAR and HSMR fordeprivation but found that the effect of this was minor and did not change ourconclusions. The three hospitals that directed GP-referred surgical patients to theemergency department had similar performance to the other hospitals that had SurgicalAdmission Units.


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)

HSMR for non-elective admissions: Emergency Assessment Unit model compared toother similar hospitals.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig4: HSMR for non-elective admissions: Emergency Assessment Unit model compared toother similar hospitals.
Mentions: There was a steady decrease in our HSMR, compared with controls during the study period(table 1). This decrease began in 2003. Thiswas maintained and was the lowest of all the hospitals in the study in 2007, 2008 and2009. The probability that the intervention hospital performed best out of 16 hospitaltrusts 3 out of 4 years is statistically significant, p=0.0149 (figure 4). We adjusted both SAR and HSMR fordeprivation but found that the effect of this was minor and did not change ourconclusions. The three hospitals that directed GP-referred surgical patients to theemergency department had similar performance to the other hospitals that had SurgicalAdmission Units.

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