Risk factors for admission at three urban emergency departments in England: a cross-sectional analysis of attendances over 1 month

Abstract

ObjectiveTo investigate factors associated with unscheduled admission following presentation to emergency departments (EDs) at three hospitals in England.Design and settingCross-sectional analysis of attendance data for patients from three urban EDs in England: a large teaching hospital and major trauma centre (site 1) and two district general hospitals (sites 2 and 3). Variables included patient age, gender, ethnicity, deprivation score, arrival date and time, arrival by ambulance or otherwise, a variety of ED workload measures, inpatient bed occupancy rates and admission outcome. Coding inconsistencies in routine ED data used for this study meant that diagnosis could not be included.Outcome measureThe primary outcome for the study was unscheduled admission.ParticipantsAll adults aged 16 and older attending the three inner London EDs in December 2013. Data on 19 734 unique patient attendances were gathered.ResultsOutcome data were available for 19 721 attendances (>99%), of whom 6263 (32%) were admitted to hospital. Site 1 was set as the baseline site for analysis of admission risk. Risk of admission was significantly greater at sites 2 and 3 (adjusted OR (AOR) relative to site 1 for site 2 was 1.89, 95% CI 1.74 to 2.05, p<0.001) and for patients of black or black British ethnicity (AOR 1.29, 1.16 to 1.44, p<0.001). Deprivation was strongly associated with admission. Analysis of departmental and hospital-wide workload pressures gave conflicting results, but proximity to the “4-hour target” (a rule that limits patient stays in EDs to 4 hours in the National Health Service in England) emerged as a strong driver for admission in this analysis (AOR 3.61, 95% CI 3.30 to 3.95, p<0.001).ConclusionThis study found statistically significant variations in odds of admission between hospital sites when adjusting for various patient demographic and presentation factors, suggesting important variations in ED-level and clinician-level behaviour relating to admission decisions. The 4-hour target is a strong driver for emergency admission.

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

“…The site for the study was a large urban teaching hospital (a major trauma centre with a hyperacute stroke unit), with an annual attendance volume of around 129 000i and an overall admission rate during the study period of 23% 22. The ED is consultant-staffed 24 hours a day, has 38 adult beds and a 14-bed CDU.…”

Review of factors that influence non-elective hospital admission(s)

“…was associated with higher transience factors to patients' presentation at the ED. In contrast, they found less influence of day of the week and time of admission on patients' mortality from unplanned admissions, reported in (Bankart et al, 2011;Arulkumaran Harrison and Brett, 2016;Ismail et al, 2017). Such demise might result from other risk factors (such as; inadequate hospital staffing), because there were more hospital presentations than available healthcare staff.…”

“…In Scotland, male sex was reported to be associated with NeHA, which might be as a result of the propensity of men to multiple prescriptions, according to . However, another study who investigated three different sites reported female sex to be associated with NeHA; an implication of which revealed lack of hospital facility as a limiting factor for those patients, reported by (Ismail et al 2017). These shortages, might be peculiar to the female gynaecology ED; where medical treatments are focused on female gender.…”

“…The health authorities, including the local councils, are concerned about the amount of money spent on patients' treatment (Veeren and Weiss, 2017;Ismail et al, 2017;Li et al, 2014).…”

“…Europe and they all have a good population sample size. Chu and Pe, 1999;Li et al, 2015;Long et al, 2016;Ismail et al, 2017).…”