The selection of acute medical admissions for a short-stay unit

Abstract

Objective of this study is to evaluate the selection of patients to be admitted to a hospital medical short-stay unit (SSU) where acute medical admissions with a predicted length of stay of between 24 and 72 h are managed. This is a retrospective observational study evaluating outcomes of all admissions to the medical SSU between January 2005 and December 2008. Factors that influence inappropriate allocation of patients to the SSU or alternative longer stay medical units were evaluated. Length of stay (LOS), mortality, Charlson score, admission to intensive care unit (ICU) (from the SSU), discharge diagnosis, and 7-day readmission rate were analysed. Over 4 years, 45% of the general medical inpatient take, 9,125 admission episodes, were managed by the medical SSU. On an average, 72% of these admissions to the SSU stayed fewer than 72 h. After excluding in-hospital deaths, there were 8,381 admissions to the general medical unit discharged within 72 h, and 77% of these were managed by the SSU during the study period. Inappropriate admissions to the SSU (LOS more than 72 h) tended to be older patients with more complex medical comorbidities. Other factors contributing to prolonged stay in the SSU included weekend admissions, and transfers to the ICU. The 7-day readmission rate was low at 3%; the all-cause hospital mortality for patients admitted to the medical SSU was 2% despite a 32% increase in workload in the medical SSU over these 4 years. In the context of fixed resources and a steeply increasing patient workload, a large proportion of general medical patients can be managed in a medical SSU with the majority being discharged home within 72 h while keeping all-cause in-hospital mortality and readmission rates low. More accurate identification of appropriate patients on admission by using a physiological clinical score and addressing operational issues particularly on weekends could lead to a more efficient SSU.

Alternatives to ward admission from the emergency department

“…An unplanned representation or transfer‐to‐ward rate of up to 10% may be acceptable, although depending on the objective for the unit higher proportions may be tolerated . Audits help to identify patient factors (co‐morbidities and need for specialist consultation) or systems factors (lack of weekend admissions and inaccessibility of diagnostic investigations) that predict stays beyond the guideline time for the unit …”

Development and validation of a tool to select patients for admission to medical short stay units

“…Data were collected on 14 different variables that might have affected length of stay. Some variables have previously been shown to predict a 'failed' short stay, that is, admission for >72 h. These include: inability to independently mobilise, ongoing active treatment, need for specialty consultation, requirement of multidisciplinary assessment, inaccessibility of diagnostic tests, weekend admissions and transfer to intensive care units 4,10,11 . Increasing age has been shown by some to be associated with increased length of stay 4 but not others.…”

“…Data were collected on 14 different variables (Table 1) using a data collection proforma. These variables were chosen because they had either previously been shown to affect length of stay 4,7,10,11 or were thought to be relevant after discussion with the multidisciplinary team.…”

“…There are also clinical needs, primarily to get the right person in the right setting at the fi rst attempt. 2 The defi nition of a 'short stay' varies, but is usually taken to be a hospital stay of <72 h. 3,4 These units have been shown to reduce length of stay without increasing readmission rates, 3 and to reduce in-hospital complications and readmissions within 30 days. 5 However, appropriate patient selection remains problematic, yet is essential to the smooth running of MSSUs.…”

Tiempo de estancia hospitalaria en pacientes ingresados por insuficiencia cardiaca aguda. Factores asociados

“…En nuestro país más de un tercio de los episodios de ICA atendidos en los SUH ingresan en la UCE 107 y de acuerdo con los datos recientemente publicados en el estudio REGICE (registro de UCE en España) 108,109 , la ICA es una de las patologías más frecuentes en dichas unidades suponiendo casi un 9% de sus ingresos. Desde el punto de vista de la gestión de los recursos y con el fin de garantizar un buen funcionamiento de estas unidades, se ha destacado la importancia de una selección adecuada de los pacientes con una correcta definición de los criterios de ingreso en la misma [110][111][112][113] . Sin embargo, los datos existentes hasta el momento sobre la adecuación de la estancia en la UCE de los pacientes con ICA son escasos.…”