Does integrated emergency care reduce mortality and non-elective admissions? a retrospective analysis
- Correspondence to Dr Adrian Boyle, Emergency Department, Addenbrookes Hospital, Hills Road, Cambridge CB2 2QQ, UK;
Contributors AB, TB, JF and SR conceived the study. VA commented and developed the methods. All authors were involved in drafting the manuscript.
- Accepted 14 February 2011
- Published Online First 17 March 2011
Objectives The authors reconfigured the emergency care system of Addenbrookes Hospital, Cambridge. The medical admissions unit and the emergency department (ED) have been combined into one emergency assessment unit. This paper aims to determine if reconfiguration has reduced non-elective hospital admissions and reduced mortality for non-elective admissions.
Design A retrospective ‘before and after’ study in a teaching hospital. Routinely collected data were used to evaluate the effectiveness of this approach.
Setting One acute trust in the UK.
Main outcome measures Inhospital mortality rates and standardised admission ratios (SAR) between 2003 and 2009.
Results There was a significant trend towards improved survival, both for non-elective admissions and deaths in the ED (z=−3.92; p>0.001), despite the age and acuity of patients increasing. There was a marked decrease in the SAR. Formal complaints, incident reports and the proportion of patients leaving before treatment declined, whereas the proportion of patients re-admitted as an emergency within 28 days did not change.
Conclusions Integrating emergency care within a hospital reduces hospital admissions, is associated with reduced inhospital mortality and a better quality of care.
- Cardiac care
- care systems
- cost effectiveness
- emergency care systems
- emergency departments
- emergency department management
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.