ObjectiveTo identify trends in emergency admissions for patients with clinical conditions classed as ‘ambulatory care sensitive’ (ACS) and assess if reductions might be due to improvements in preventive care.DesignObservational study of routinely collected hospital admission data from March 2001 to April 2011. Admission rates were calculated at the population level using national population estimates for area of residence.ParticipantsAll emergency admissions to National Health Service (NHS) hospitals in England from April 2001 to March 2011 for people residents in England.Main outcome measuresAge-standardised emergency admissions rates for each of 27 specific ACS conditions (ICD-10 codes recorded as primary or secondary diagnoses).ResultsBetween April 2001 and March 2011 the number of admissions for ACS conditions increased by 40%. When ACS conditions were defined solely on primary diagnosis, the increase was less at 35% and similar to the increase in emergency admissions for non-ACS conditions. Age-standardised rates of emergency admission for ACS conditions had increased by 25%, and there were notable variations by age group and by individual condition. Overall, the greatest increases were for urinary tract infection, pyelonephritis, pneumonia, gastroenteritis and chronic obstructive pulmonary disease. There were significant reductions in emergency admission rates for angina, perforated ulcers and pelvic inflammatory diseases but the scale of these successes was relatively small.ConclusionsIncreases in rates of emergency admissions suggest that efforts to improve the preventive management of certain clinical conditions have failed to reduce the demand for emergency care. Tackling the demand for hospital care needs more radical approaches than those adopted hitherto if reductions in emergency admission rates for ACS conditions overall are to be seen as a positive outcome of for NHS.
How to obtain copies of this and other HTA programme reports An electronic version of this publication, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable CD-ROM is also available (see below).Printed copies of HTA monographs cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our Despatch Agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. Ipswich Hospital, Ipswich, UK HTA *Corresponding authorObjectives: To determine the comparative effectiveness and cost-effectiveness of three dressing products, N-A ® , Inadine ® and Aquacel ® , for patients with diabetic foot ulcers, as well as the feasibility and consequences of less frequent dressing changes by health-care professionals. Design: A multicentre, prospective, observer-blinded, parallel group, randomised controlled trial, with three arms. Setting: Established expert multidisciplinary clinics for the management of diabetic foot ulcers across the UK. Participants: Patients over age 18 with type 1 or type 2 diabetes with a chronic (present for at least 6 weeks) full-thickness foot ulcer (on or below the malleoli) not penetrating to tendon, periosteum or bone, and with a cross-sectional area between 25 and 2500 mm 2 .Interventions: Participants were randomised 1:1:1 to treatment with one of N-A (a non-adherent, knitted, viscose filament gauze), Inadine (an iodine-impregnated dressing), both traditional dressings, or Aquacel, a newer product. Main outcome measures: The primary outcome ...
The early recognition and goal-directed management of severely septic patients has been shown to reduce mortality. This study aimed to determine compliance with the ‘Surviving Sepsis' guidelines and to analyse the systems involved in delivering care in a UK teaching hospital. Patients from any hospital department with clinically significant positive blood cultures (n=229) were identified. Adults who met criteria for severe sepsis and who were deemed suitable for active management were included (n=46). None of the patients received all bundle elements within the advised time limits. Only 52% had received broad-spectrum antibiotics within three hours of presentation and only 57% had adequate fluid resuscitation within six hours. The median time from presentation to doctor involvement was 1.1 hours, with a delay of 3.9 hours to see a senior clinician. The median time from presentation to admission to the high dependency unit (HDU) or intensive care unit (ICU) was 12.9 hours. This study has shown that the early recognition and resuscitation of septic patients is unreliable and the capacity to provide early antimicrobial and goal-directed therapy for septic patients is limited in a UK teaching hospital.
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