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Integrated emergency care reduces hospital admissions and reduces in hospital mortality
  1. Adrian Boyle

Abstract

Introduction We closed our Medical Admissions Unit and relocated the staff into an enlarged Emergency Department. We streamlined our assessment processes to reduce duplication of effort. We aimed to evaluate the effect of this on mortality, admission ratios and quality of care.

Methods We evaluated the effectiveness of this approach using multiple routinely collected measures. We studied the 3 years before the change and 3 years afterward in our centre. We obtained an independent analysis of our standardised admission ratios by the Dr Foster unit. We evaluated mortality with Dr Foster data. We evaluated quality of care by comparing the numbers of complaints, incident forms and re-admissions.

Results There was a decline in the standardised admissions ratios from 105.8 (95% CI 104.9 to 106.6) in 2003 to 89.5 (95% CI 88.8 to 90.2) in 2009. Hospital Mortality for non-elective admissions also fell slightly. All measures of quality improved or were unchanged after the change.

Discussion Integrating Emergency Care in one place is associated with substantial reductions in admissions. This system is associated with a slight reduction in mortality and improved quality of care measures.

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