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Urgent care axis for the older adult: where is best to target interventions?
  1. Jonathan Graeme Bunn1,
  2. Susan Jane Croft1,
  3. Colin O’Keeffe1,
  4. Richard M Jacques1,
  5. Rebecca M Simpson1,
  6. Tony Stone1,
  7. Simon Paul Conroy2,
  8. Suzanne M Mason1
  1. 1School of Health and Related Research, University of Sheffield, Sheffield, UK
  2. 2Department of Health Sciences, University of Leicester, Sheffield, UK
  1. Correspondence to Dr Susan Jane Croft, School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK; s.croft{at}sheffield.ac.uk

Abstract

Background We explored the urgent care axis across EDs in Yorkshire and Humber (Y&H) for patients aged ≥75 years to identify where interventions could be targeted to prevent ED attendances and inpatient admissions.

Methods Hospital Episode Statistics (HES) data for attendances across 18 EDs in Y&H from April 2011 to March 2014 were retrospectively analysed. HES A&E and Admitted Patient Care patient records data were linked to describe the entire patient pathway. The population studied was adult patients attending type 1 EDs, comparing those ≥75 years with those under 75. Data analysed included arrival mode, presentation time, time in ED, outcome (admitted/discharged), admission length of stay, International Classification of Diseases 10th Revision (ICD-10) and cause codes related to admission. Short-stay admissions and admissions with potentially avoidable conditions (identified by ICD-10 codes and cause codes) were identified. Comparative analysis was undertaken between sites.

Results There were 3 736 541 ED attendances, of which 625 772 (16.7%) were ≥75 years. Older patients were significantly more likely to attend via ambulance than the younger cohort (OR 7.7, 95% CI 7.6 to 7.7), and had significantly longer median stays within ED (195 vs 136 min, p<0.001) and increased likelihood of admission (OR 4.5, 95% CI 4.5 to 4.6). Short-stay admissions accounted for 28.3% of older adult admissions. 37.3% of older adult admissions were with conditions that were potentially avoidable, accounting for 42.3% of short-stay admissions. There was regional variation in the proportions of older adults admitted (between 34.3% and 40.9%).

Discussion Large numbers of older adults present to EDs mainly by ambulance. Significant proportions are admitted for short periods with conditions that might potentially be managed outside of hospital. Variation across the region warrants further study.

  • aged
  • emergency care systems
  • admission avoidance
  • acute care

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Footnotes

  • Contributors JGB, SMM, COK and SPC conceived the study. JGB performed the background searches. Data linkage was performed by TS and statistical analysis of results by RMJ and RMS. Interpretation of data was performed by JGB, SMM, COK and SJC. JGB and SJC drafted the initial manuscript and all authors contributed to its revision.

  • Funding The research was funded by the NIHR CLAHRC Yorkshire and Humber, www.clahrc- yh.nihr.ac.uk.

  • Disclaimer The views expressed are those of the author(s), and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests The authors report grants from NIHR, inside and outside the submitted work.

  • Patient consent Not required.

  • Ethics approval NHS Health Research Authority (HRA): National Research Ethics Service Committee South West Exeter (14/SW/1014).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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