Trends in hospital inpatient episodes for signs, symptoms and ill-defined conditions: observational study of older peoples hospital episodes in England, 1995-2003

School of Nursing and Midwifery, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
Age and Ageing (Impact Factor: 3.11). 08/2008; 37(4):455-8. DOI: 10.1093/ageing/afn099
Source: PubMed
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    ABSTRACT: Key Words: Rise in emergency admissions, increasing medical admissions, short stay emergency admission, mechanisms for growth, vague diagnoses, signs & symptoms, demography, same (zero) day stay admissions, new infectious immune disease Key Points • Seven mechanisms for growth appear to regulate the trends in emergency admissions. • Demographic change, re-admissions and rising expectations account for less than a 2% per annum increase and fail to explain the more dynamic changes. • A major part of the gap between the demographic and actual increase is due to short stay (mainly zero day) emergency admissions and it is perhaps better to treat these as an extension of ambulatory care (which includes A&E) rather than emergency admissions per se. • Length of stay (LOS) efficiency for emergency admission should be re-calibrated by excluding zero day stay emergency admissions as should apparent rates of 'admission' for particular diagnoses. • The seasonal variation in admission to the medical group of specialties is shown to be very high and this refutes claims that emergency admissions are 'predictable'. • If hospitals and primary care are to allocate scarce resources to minimise costs then supporting tools which forecast health based on the weather and environment are an absolute necessity. Series Summary Part one of this series discusses how the more widely recognised factors such as an aging population, re-admissions and increasing expectations of medicine only contribute to a baseline increase in emergency admissions. Seasonal variation is discussed in the context of the predictability or otherwise of emergency admissions in response to changes in the weather and the wider environment. However these are unable to explain the observed cyclical events occurring every four to six years in medicine and even longer cycles in surgical and trauma admissions. These cycles are discussed in part two while part three investigates the implications to bed planning. The current methods for estimating the size of hospitals and bed pools within hospitals are shown to be inappropriate to the real needs of emergency care. Part four investigates financial risk associated with emergency admissions.
    British Journal of Health Care Management 04/2009; 15(4). DOI:10.12968/bjhc.2009.15.4.41722
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    ABSTRACT: Explores demographic and socio-economic factors behind patient non-attendance at outpatient clinics.
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    ABSTRACT: Risk seems to plateau, but other causes of death are poorly defined
    BMJ (online) 02/2008; 337:a2521. DOI:10.1136/bmj.a2521 · 16.38 Impact Factor
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