Richard Conway1, Declan Byrne1, Seán Cournane2, Deirdre O'Riordan1, Bernard Silke3. 1. Department of Internal Medicine, St. James's Hospital, Dublin 8, Ireland. 2. Department of Medical Physics and Bioengineering, St. James's Hospital, Dublin 8, Ireland. 3. Department of Internal Medicine, St. James's Hospital, Dublin 8, Ireland. bernardsilke@physicians.ie.
Abstract
BACKGROUND: The Acute Medical Admission Unit (AMAU) model of care has been associated with improved short- and medium-term outcomes; whether these improvements are sustained remains unclear. We report on the 15-year outcomes of an AMAU in our institution. METHODS: All emergency medical admissions between 2002 and 2016 were examined and 30-day in-hospital mortality, admission rates, readmission rates and length of stay (LOS) assessed. We used logistic and Poisson regression and margin statistics to evaluate outcomes. RESULTS: There were 96,305 admissions in 50,612 patients. By admission, the 30-day in-hospital mortality averaged 5.6% (95% CI 5.4 to 5.7%); there was a relative risk reduction (RRR) of 33.9% between 2002 and 2016, from 7.0 to 4.6% (p = 0.001), number need to treat (NNT) 41.9. By unique patient the 30-day in-hospital mortality averaged 10.5% (95% CI 10.3 to10.8%); there was a RRR of 61.7% between 2002 and 2016, from 15.1 to 5.8% (p = 0.001), NNT 10.7. The median LOS was 5.0 days (IQR 2.1, 9.8) and was unaltered over time. Deprivation status strongly influenced the admission rate/1000 population increasing from Q1 7.7 (95% CI 7.6 to 7.8) to Q5 37.8 (95% CI 37.6 to 38.0); this showed a slight trend to increase over time. Total readmissions increased as a function of time; early readmissions (< 4 weeks) remained constant 10.5% (95% CI 9.6 to 11.3). CONCLUSION: The 30-day in-hospital mortality showed a linear trend to reduce over the 15 years following the institution of an AMAU; other key parameters were unaltered.
BACKGROUND: The Acute Medical Admission Unit (AMAU) model of care has been associated with improved short- and medium-term outcomes; whether these improvements are sustained remains unclear. We report on the 15-year outcomes of an AMAU in our institution. METHODS: All emergency medical admissions between 2002 and 2016 were examined and 30-day in-hospital mortality, admission rates, readmission rates and length of stay (LOS) assessed. We used logistic and Poisson regression and margin statistics to evaluate outcomes. RESULTS: There were 96,305 admissions in 50,612 patients. By admission, the 30-day in-hospital mortality averaged 5.6% (95% CI 5.4 to 5.7%); there was a relative risk reduction (RRR) of 33.9% between 2002 and 2016, from 7.0 to 4.6% (p = 0.001), number need to treat (NNT) 41.9. By unique patient the 30-day in-hospital mortality averaged 10.5% (95% CI 10.3 to10.8%); there was a RRR of 61.7% between 2002 and 2016, from 15.1 to 5.8% (p = 0.001), NNT 10.7. The median LOS was 5.0 days (IQR 2.1, 9.8) and was unaltered over time. Deprivation status strongly influenced the admission rate/1000 population increasing from Q1 7.7 (95% CI 7.6 to 7.8) to Q5 37.8 (95% CI 37.6 to 38.0); this showed a slight trend to increase over time. Total readmissions increased as a function of time; early readmissions (< 4 weeks) remained constant 10.5% (95% CI 9.6 to 11.3). CONCLUSION: The 30-day in-hospital mortality showed a linear trend to reduce over the 15 years following the institution of an AMAU; other key parameters were unaltered.
Entities:
Keywords:
Acute medical admissions unit; Admission rate; Emergency medical admissions; Mortality; Readmissions
Authors: Danielle Courtney; Richard Conway; John Kavanagh; Deirdre O'Riordan; Bernard Silke Journal: Postgrad Med J Date: 2014-04-02 Impact factor: 2.401
Authors: John Ty Soong; Audrey LA Wong; Imogen O'Connor; Milka Marinova; Dale Fisher; Derek Bell Journal: Clin Med (Lond) Date: 2021-08-10 Impact factor: 5.410