The Simple Clinical Score: a tool for benchmarking of emergency admissions in acute internal medicine

Abstract

-Quality of care in intensive care and surgery has benefited from establishing comparative standards. At present there is no accepted tool to compare outcomes for emergency admissions in internal medicine. The Simple Clinical Score (SCS) was used in 1,098 consecutive medical emergency admissions to adjust mortality for severity of illness. Hospital mortality adjusted for severity of illness and length of stay in the cohort was in keeping with mortality in the Irish derivation study with a trend towards lower mortality in the very high-risk group. Three parameters with poor reproducibility were identified. The SCS has several potential applications: identification of patients with low risk of death suitable for early hospital discharge; early identification of patients with a high risk of death, who will require care in critical care areas (or specialist palliative care); and benchmarking of acute medical departments internationally in a similar way to how APACHE II scoring has been used in critical care units worldwide. 1

Judging performance in general medicine

“…While generated to predict 30‐day mortality risk, it may prove to be a valuable tool for assessing and comparing the quality of clinical care between different units or different hospitals. Our comparison of a recent Royal Adelaide Hospital study with three other published studies on the SCS show similar trends across the four sites for a variety of outcomes despite the GM units being of differing sizes (36–120 beds), hospitals of differing sizes (180–980 beds), catchments of differing sizes (60 000–1 200 000) containing mostly rural patients or mostly urban (Table ). We suggest that the SCS has the potential to be used, together with RSI, as a tool to compare performance of different sites because it controls for some crucial patient factors beyond those used to calculate the RSI.…”

The risk of adverse outcomes in hospitalized older patients in relation to a frailty index based on a comprehensive geriatric assessment

“…Even so, the sample is not small, and variability is evident, so selection bias for a uniform population does not appear to be operating. A larger study would also allow for fuller exploration of sex-differences, differences in residence prior to admission, and differences in relation to other measures of illness severity [39]. The inter-rater reliability study was not blinded, although this is mitigated by much of the data coming from the health record, entered by people blind to the intent of test-retest reliability.…”

A pragmatic triage system to reduce length of stay in medical emergency admission: Feasibility study and health economic analysis

“…The Simple Clinical Score ( Fig. 1) has been shown in several studies to detect these patients with a very low risk of death [8,20,21]. Not only could early treatment prevent some of these "low risk" patients becoming "high risk" patients and improve their outcome [11], but also their efficient management could potentially yield considerable cost savings.…”