The corridors of uncertainty: a focus on emergency department admission processes

In this issue of the Emergency Medicine Journal we have two papers exploring admission processes; hospital admission thresholds and admission avoidance.

First, Wyatt and colleagues, in a retrospective analysis of a database of over 20 million (!) patients, examine hospital admission thresholds across 47 EDs over a 5 year period. After adjusting for various measures of acuity, they demonstrate a 3% reduction in admissions over the study period. The authors estimate that 137 000 hospital admissions were avoided across selected hospitals in 2015. This important work demonstrate how Emergency Medicine practice is changing, with ED clinicians adopting a higher threshold for admission, despite increasing acuity and medical complexity. The accompanying commentary by Boyle and Weber urges us to be mindful that policies that encourage avoidance of hospital admission at all costs may not always be in the best interests of patients.

Second, Ibrahim et al, evaluate outpatient intravenous antibiotics for children with moderate/severe cellulitis. This observational analysis of 115 children selected for either home treatment or hospital treatment demonstrated no significant differences in rates of treatment failure, duration of treatment …