Can a change in policy reduce emergency hospital admissions? Effect of admission avoidance team, guideline implementation and maximising the observation unit

Gonnah, R; Hegazi, Mohamed Osama; Hmdy, I; Shenoda, Michael

doi:10.1136/emj.2007.053090

Cited by 12 publications

(6 citation statements)

References 28 publications

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“…The hospital admission rate in our cohort (4.1%), in keeping with recent U.S. data, represents a reduction from previous (8.2%) identified employing the same data set 5 years earlier . This may represent improvements in management, including the use of novel therapeutics or implementation of policies designed to reduce admissions to overcome inpatient bed shortages . Our study, which was designed to evaluate whether the implementation of embedded, evidence‐based care strategies was associated with the aforementioned improvements, found that the existence of order sets, pathways, and medical directives was not associated with reductions in admissions.…”

Section: Discussionsupporting

confidence: 78%

Evaluating the Impact of Clinical Decision Tools in Pediatric Acute Gastroenteritis: A Population‐based Cohort Study

Bahm

Freedman

Guan

et al. 2016

Academic Emergency Medicine

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Objective: Acute gastroenteritis (AGE) is a leading cause of pediatric emergency department (ED) visits. Despite evidence-based guidelines, variation in adherence exists. Clinical decision tools can enhance evidence-based care, but little is known about their use and effectiveness in pediatric AGE. This study sought to determine if the following tools-1) pathways/order sets, 2) medical directives for oral rehydration therapy (ORT) or ondansetron, and 3) printed discharge instructions-are associated with AGE admission and ED revisits.Methods: This was a retrospective population-based cohort study of all children 3 months-18 years with an AGE ED visit in Ontario, Canada, from 2008 to 2010, using linked survey and health administrative databases. Logistic regression models associating clinical decision tools (CDTs) with hospitalizations and revisits controlling for hospital and patient characteristics were employed.Results: Of the 57,921 patient visits during the study period, there were 2,401 hospitalizations (4.2%). A total of 55,520 patients were discharged from the ED, with 2,378 (4.3%) experiencing a 72-hour return visit. In adjusted models, none of the tools were significantly associated with admission. Medical directive for ORT was associated with lower return visit rates (adjusted odds ratio [aOR] = 0.86, 95% confidence interval [CI] = 0.79-0.94] and printed discharge instructions with higher return visits (aOR = 1.33, 95% CI = 1.08-1.65); pathways/order sets and medical directives for ondansetron had no association.

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Section: Discussionsupporting

confidence: 78%

Evaluating the Impact of Clinical Decision Tools in Pediatric Acute Gastroenteritis: A Population‐based Cohort Study

Bahm

Freedman

Guan

et al. 2016

Academic Emergency Medicine

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“…In addition, we found that correlates of ED use were heterogeneous based on location in an urban versus suburban or rural region. Thus, public health policy solutions for improving the delivery of acute care must consider that the effect of interventions will depend on the population in question, and that there appears to be interactive effects of geography and population characteristics [3,47]. We believe our methods allow for a nuanced understanding of community health and the drivers of ED utilization that will inform the development of targeted interventions for geographic areas and local populations with high ED use.…”

Section: Discussionmentioning

confidence: 99%

Geographic variation in the demand for emergency care: A local population-level analysis

et al. 2016

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“…There is some evidence that early assessment by experienced doctors and nurses in an emergency department reduces emergency admissions. 16–18 There is a large literature that examines how to improve processes within an emergency department, but little of this measures patient-orientated outcomes. 19–24 Future work should attempt to validate these findings across different hospitals.…”

Section: Discussionmentioning

confidence: 99%

Reductions in hospital admissions and mortality rates observed after integrating emergency care: a natural experiment

et al. 2012

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ObjectivesReducing 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.DesignQuasi-experimental before and after study using routinely collected data.Setting and participants1 acute hospital in England, the intervention site, was compared with 23 other English hospitals between 2001 and 2009.Outcome measuresOur outcome measures were hospital standardised mortality ratios (HSMRs) for non-elective admissions and standardised admission ratios (SARs).ResultsThe 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.ConclusionIntegrating emergency care in one location is associated with a meaningful reduction in mortality and emergency admissions to hospital.

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Can a change in policy reduce emergency hospital admissions? Effect of admission avoidance team, guideline implementation and maximising the observation unit

Abstract: A multidisciplinary emergency department policy, using as much available evidence as possible, was successful in significantly reducing medical hospital admissions in spite of the rising numbers of patients visiting the emergency department and observation unit.

Cited by 12 publications

References 28 publications

Evaluating the Impact of Clinical Decision Tools in Pediatric Acute Gastroenteritis: A Population‐based Cohort Study

Evaluating the Impact of Clinical Decision Tools in Pediatric Acute Gastroenteritis: A Population‐based Cohort Study

Geographic variation in the demand for emergency care: A local population-level analysis

Reductions in hospital admissions and mortality rates observed after integrating emergency care: a natural experiment

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