Dataset Information

Factors influencing emergency medical readmission risk in a UK district general hospital: A prospective study.

ABSTRACT: BACKGROUND: Over recent years increased emphasis has been given to performance monitoring of NHS hospitals, including overall number of hospital readmissions, which however are often sub-optimally adjusted for case-mix. We therefore conducted a study to examine the effect of various patient and disease factors on the risk of emergency medical readmission. METHODS: The study setting was a District General Hospital in Greater Manchester and the study period was 4.5-years. All index emergency medical admission during the study period leading to a live discharge were included in the study (n = 20,209). A multivariable proportional hazards modelling was used, based on Hospital Episodes Statistics data, to examine the influence of various baseline factors on readmission risk. Deprivation status was measured with the Townsend deprivation index score. Hazard ratios (HR) and associated 95% confidence intervals (CI) of unplanned emergency medical admission by sex, age group, admission method, diagnostic group, number of coded co-morbidities, length of stay and patient's deprivation status quartile, were calculated. RESULTS: Significant independent predictors of readmission risk at 12 months were male sex (HR 1.13, CI: 1.07-1.2), age (age >75 (HR 1.57, CI 1.45-1.7), number of coded co-morbidities (HR for >4 coded co-morbidities: 1.49 CI: 1.26-1.76), admission via GP referral (HR 0.93, CI 0.88-0.99) and primary diagnosis of heart failure (HR 1.33, CI: 1.16-1.53) and chronic obstructive pulmonary disease/asthma (HR 1.34, CI: 1.21-1.48). Higher level of deprivation was also significantly and independently associated and with increased emergency medical readmission risk at three (HR for the most deprived quartile 1.21, CI: 1.08-1.35), six (HR 1.21, CI: 1.1-1.33) and twelve months (HR 1.25, CI: 1.16-1.36). CONCLUSIONS: There is a potential for improving health and reducing demand for emergency medical admissions with more effective management of patients with heart failure and chronic obstructive airways disease/asthma. There is also a potential for improving health and reducing demand if reasons for increased readmission risk in more deprived patients are understood. The potential influence of deprivation status on readmission risk should be acknowledged, and NHS performance indicators adjustment for deprivation case-mix would be prudent.

SUBMITTER: Lyratzopoulos G

PROVIDER: S-EPMC548275 | biostudies-literature | 2005 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Factors influencing emergency medical readmission risk in a UK district general hospital: A prospective study.

Lyratzopoulos Georgios G Havely Daniel D Gemmell Islay I Cook Gary A GA

BMC emergency medicine 20050121 1

BACKGROUND: Over recent years increased emphasis has been given to performance monitoring of NHS hospitals, including overall number of hospital readmissions, which however are often sub-optimally adjusted for case-mix. We therefore conducted a study to examine the effect of various patient and disease factors on the risk of emergency medical readmission. METHODS: The study setting was a District General Hospital in Greater Manchester and the study period was 4.5-years. All index emergency medic ...[more]

PMID: 15663793

Similar Datasets

Project description:BackgroundEmergency Department attendance is increasing internationally, of which a significant proportion could be managed in general practice. In England, policies backed by substantial capital funding require such patients attending Emergency Departments be directed or 'streamed' to General Practitioners working in or parallel to Emergency Departments. However, evidence for streaming is limited and the processes of streaming patients attending Emergency Departments to General Practitioners lacks exploration.ObjectivesThis paper explores streaming to General Practitioners in and alongside Emergency Departments at ten sites across England. It highlights positive streaming practice, as well as issues that may contribute to poor streaming practice, in order to inform future service improvement.MethodsA longitudinal qualitative study was conducted with data collected between October 2017 and December 2019 across 10 case study sites throughout England as part of a broader mixed methods study. 186 non-participant observations and 226 semi-structured interviews with 191 health professionals working in Emergency Departments or related General Practitioner Services were thematically analysed in relation to streaming processes and experiences.ResultsSix interconnected themes influencing streaming were identified: implementing and maintaining structural support; developing and supporting streaming personnel; implementing workable and responsive streaming protocols; negotiating primary/secondary care boundaries; developing and maintaining interprofessional relationships and concerns for patient safety. Streaming was considered central to the success of General Practitioners in/parallel to Emergency Departments. The importance of the skills of streaming nurses in delivering an optimal and safety critical service was highlighted, as was the skillset of General Practitioners and interprofessional relationships between streamers and General Practitioners. There was no distinct streaming model or method associated with good streaming practice to General Practitioners in/alongside Emergency Departments, instead factors for success were identified and key recommendations suggested. 'Inappropriate' streaming was identified as a problem, where patients streamed to General Practitioners in or parallel to Emergency Departments required Emergency Department management, or patients suitable for General Practitioner care were kept in the Emergency Department.ConclusionDespite adopting differing methods, commonalities across case sites in the delivery of good streaming practice were identified, leading to identification of key recommendations which may inform development of streaming services.Study registrationISRCTN51780222. Tweetable abstract: Workplace culture and the skillset of streamers and General Practitioners is crucial to streaming of patients to General Practitioners in Emergency Departments.

Project description:OBJECTIVE:To examine the influence of patient-level sociodemographic factors on the incidence of hospital readmission within 30 days among medical patients in a large Canadian metropolitan city. DESIGN:Prospective cohort study. SETTING AND PARTICIPANTS:Patients admitted to the General Internal Medicine service of an urban teaching hospital in Toronto, Canada participated in a survey of sociodemographic information. Patients were not surveyed if deemed medically unstable, receiving care in medical/surgical step-down beds or were isolated for infection control. Included in the final analysis was a diverse cohort of 1427 adult, non-palliative, patients who were discharged home. MEASURES:Thirteen patient-level sociodemographic variables were examined in relation to time to unplanned all-cause readmission within 30 days. Illness level was accounted for by the following covariates: self-perceived health status, previous hospital utilisation, primary diagnosis case mix group, Charlson Comorbidity Index score and inpatient length of stay. RESULTS:Approximately, 14.4% (n=205) of patients experienced readmission within 30 days. Sociodemographic factors were not significantly associated with time to readmission in unadjusted and adjusted analyses. Indicators of illness level, namely, previous hospitalisations, were the strongest risk factors for readmission within this cohort. One previous admission (adjusted HR 1.78; 95% CI 1.22 to 2.59, P<0.01) and at least four previous emergency department visits (adjusted HR 2.33; 95% CI 1.46 to 4.43, P<0.01) were associated with increased hazard of readmission within 30 days. CONCLUSIONS:Patient-level sociodemographic factors did not influence the incidence of unplanned all-cause readmission within 30 days. Further research is needed to understand the generalisability of our findings and investigate whether contextual factors, such as access to universal health insurance coverage, attenuate the effects of sociodemographic factors.

Project description:BACKGROUND:Whether types of hospitals with high readmission rates also have high overall postdischarge acute care utilization (including emergency department and observation care) is unknown. DESIGN:Cross-sectional analysis. SUBJECTS:Nonfederal United States acute care hospitals. MEASURES:Using methodology established by the Centers for Medicare & Medicaid Services, we calculated each hospital's "excess days in acute care" for fee-for-service (FFS) Medicare beneficiaries aged over 65 years discharged after hospitalization for acute myocardial infarction, heart failure (HF), or pneumonia, representing the mean difference between predicted and expected total days of acute care utilization in the 30 days following hospital discharge, per 100 discharges. We assessed the multivariable association of 8 hospital characteristics with excess days in acute care and the proportion of hospitals with each characteristic that were statistical outliers (95% credible interval estimate does not include 0). RESULTS:We included 2184 hospitals for acute myocardial infarction [228 (10.4%) better than expected, 549 (25.1%) worse than expected], 3720 hospitals for HF [484 (13.0%) better and 840 (22.6%) worse], and 4195 hospitals for pneumonia [673 (16.0%) better, 1005 (24.0%) worse]. Results for all conditions were similar. Worse than expected outliers for pneumonia included: 18.8% of safety net hospitals versus 26.1% of nonsafety net hospitals; 16.7% of public hospitals versus 33.1% of for-profit hospitals; 19.5% of nonteaching hospitals versus 52.2% of major teaching hospitals; 7.9% of rural hospitals versus 42.1% of large urban hospitals; 5.9% of hospitals with 24-<50 beds versus 58% of hospitals with >500 beds; and 29.0% of hospitals with nurse-to-bed ratios >1.0-1.5 versus 21.7% of hospitals with ratios >2.0. CONCLUSIONS:Including emergency department and observation stays in measures of postdischarge utilization produces similar results as measuring only readmissions in that major teaching, urban and for-profit hospitals still perform disproportionately poorly versus nonteaching or public hospitals. However, it enables identification of more outliers and a more granular assessment of the association of hospital factors and outcomes.

Project description:Hypokalaemia is prevalent in 20% of hospitalised patients. Furthermore, inadequate management of hypokalemia was identified in 24% of these patients. Associated with significant patient morbidity and mortality, the identification, investigation, and treatment of hypokalaemia was identified as an area for improvement in the management of medical inpatients. The project aims to measure the assessment, management, and therapeutic monitoring of medical inpatients with hypokalaemia in a district general hospital. All medical inpatients over a one week period who met the criteria for hypokalaemia (serum potassium <3.5 mmol/L on standard biochemical sample) were included in the audit. Patient's notes were located and evaluated to identify if they had mild, moderate, or severe hypokalaemia. Further data on ECG requests, repeat U&Es, serum magnesium analysis, treatment prescribed, and medication review dates was collated. A re-audit was completed after the introduction of a set of interventions which included a hypokalaemia treatment algorithm. Pre-intervention analysis of all medical inpatients, who met our inclusion criteria for hypokalaemia, identified 32 patients. 25 of these patients met the criteria for mild hypokalaemia (3.1-3.4 mmol/L) and 7 met the criteria for moderate hypokalaemia (2.5-3.0 mmol/L). Only 7/32 (22 %) patients were receiving adequate treatment based on trust guidelines. Post intervention results showed marked improvement in the management of patients with hypokalaemia. A total of 30 patients were identified in this post-intervention group. There were 16/30 patients who qualified as mild hypokalaemia (3.1-3.4 mmol/L) and 14/30 with moderate hypokalaemia (2.5-3.0 mmol/L). 19/30 (63%) patients in the post-intervention group were correctly prescribed appropriate medication doses consistent with the treatment algorithm. Following the initial success of the project, analysis at 3 months showed a positive trend for sustained improvement when compared to the pre-intervention results.

Dataset Information

Factors influencing emergency medical readmission risk in a UK district general hospital: A prospective study.

Publications

Factors influencing emergency medical readmission risk in a UK district general hospital: A prospective study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets