R McMullan1, B Silke, K Bennett, S Callachand. 1. Department of Infectious Disease, Royal Victoria Hospital, and General Internal Medicine, Belfast City Hospital, Belfast, UK.
Abstract
OBJECTIVES: To describe the patient demographic characteristics and organisational factors that influence length of stay (LOS) among emergency medical admissions. Also, to describe differences in investigation practice among consultant physicians and to examine the impact of these on LOS. DESIGN: Prospective observational study. SETTING: General medicine department of a teaching hospital in Belfast, UK. PARTICIPANTS: Data were recorded for patients who were admitted as emergencies and reviewed on the post-take ward rounds (PTWR) attended by the investigation coordinator. OUTCOME MEASURES: Non-laboratory investigations requested, LOS, and diagnosis on discharge. RESULTS: Of 830 episodes evaluated, the median LOS was 7 days (interquartile range 3-12 days); this was significantly longer for admissions on Fridays (p = 0.0011) and for patients managed on medical wards (p<0.0001). There was a positive correlation between patient age and LOS (r = 0.32, p<0.0001). Chest radiographs (p = 0.002) and echocardiography (p = 0.015) were associated with a prolonged LOS; no investigations were associated with a shortened LOS. Diagnoses of congestive heart failure, respiratory disease, and cancer were associated with a longer LOS; a diagnosis of angina was associated with a shorter LOS. Considerable variation in investigation ordering, but no difference in LOS, was observed between consultants. High use of a given medical test did not correlate with high use of other tests. CONCLUSION: A systematic means of dealing with the NHS resource crisis should include an improved organisational strategy as well as social care provision. A more unified approach to investigation practice should also have a sparing effect on resources.
OBJECTIVES: To describe the patient demographic characteristics and organisational factors that influence length of stay (LOS) among emergency medical admissions. Also, to describe differences in investigation practice among consultant physicians and to examine the impact of these on LOS. DESIGN: Prospective observational study. SETTING: General medicine department of a teaching hospital in Belfast, UK. PARTICIPANTS: Data were recorded for patients who were admitted as emergencies and reviewed on the post-take ward rounds (PTWR) attended by the investigation coordinator. OUTCOME MEASURES: Non-laboratory investigations requested, LOS, and diagnosis on discharge. RESULTS: Of 830 episodes evaluated, the median LOS was 7 days (interquartile range 3-12 days); this was significantly longer for admissions on Fridays (p = 0.0011) and for patients managed on medical wards (p<0.0001). There was a positive correlation between patient age and LOS (r = 0.32, p<0.0001). Chest radiographs (p = 0.002) and echocardiography (p = 0.015) were associated with a prolonged LOS; no investigations were associated with a shortened LOS. Diagnoses of congestive heart failure, respiratory disease, and cancer were associated with a longer LOS; a diagnosis of angina was associated with a shorter LOS. Considerable variation in investigation ordering, but no difference in LOS, was observed between consultants. High use of a given medical test did not correlate with high use of other tests. CONCLUSION: A systematic means of dealing with the NHS resource crisis should include an improved organisational strategy as well as social care provision. A more unified approach to investigation practice should also have a sparing effect on resources.