Emergency Admission Rates Research Articles

Premature mortality and disparities in kidney healthcare for people with chronic kidney disease and severe mental health difficulties.

People with severe mental health difficulties, including schizophrenia, bipolar disorder and psychosis, have higher risk of chronic kidney disease (CKD). Little was known regarding clinical outcomes and utilisation of kidney care for people with CKD and severe mental health difficulties. We conducted a retrospective cohort analysis of individuals with CKD attending a tertiary renal unit in London, between 2006 and 2019. Individuals with severe mental health difficulty diagnoses were identified, and differences between those with and without severe mental health difficulties were analysed. Of the 5105 individuals with CKD, 112 (2.2%) had a recorded severe mental health difficulty diagnosis. The mean lifespan of those with severe mental health difficulties was 13.1 years shorter than those without severe mental health difficulties, t(1269) = 5.752, p < 0.001. People with severe mental health difficulties had more advanced CKD at their first nephrology appointment. There were no statistically significant differences between groups in the rates of kidney failure, age at onset of kidney failure, or time elapsed between first appointment and death/kidney failure. The number of inpatient admissions was similar between groups, but those with severe mental health difficulties had higher rates of emergency and ICU admissions. Among individuals on renal replacement therapy (RRT), those with severe mental health difficulties were less likely to receive a kidney transplant and peritoneal dialysis. For patients receiving haemodialysis, those with severe mental health difficulties had a higher proportion of shortened sessions, greater mean weight loss during sessions, and a higher proportion of serum potassium and phosphate levels outside normal ranges. Findings illustratea number of disparities in kidney healthcare betweenpeople with and without severe mental health difficulties, underscoring the need for interventions which prevent premature mortality and improve kidney care for this population.

Remote management of worsening heart failure events and subsequent rate of emergency department admission

Abstract Background Worsening heart failure (WHF) is the leading cause of hospitalization among individuals aged ≥ 65 years and constitutes a substantial burden for both the patient and the healthcare systems. Moreover, heart failure contributes to exacerbate the pressure on emergency departments which are involved in 64% of heart failure hospital admission (1). Remote management of heart failure as been shown to reduce the number of days lost due to unplanned cardiovascular hospitalizations and all-cause mortality (2, 3), but little is known about the effect on the emergency healthcare use. We aimed to describe the effect of a telemonitoring program on the rate of emergency admissions for WHF in chronic heart failure patients. Methods All patients enrolled in the heart failure remote management program of two French centers between 13 April 2020 and 31 January 2023 were included in the study. Follow-up data were collected until 31 January 2023. Inclusion criteria were chronic heart failure (HF) with New York Heart Association ≥II and an elevated B-type natriuretic peptide (BNP &amp;gt; 100 pg/mL or N-terminal-pro-BNP &amp;gt; 1000 pg/mL). Remote evaluation included measurements of body weight, blood pressure, heart rate, symptoms, biochemical parameters, and data from cardiac implantable electronic devices when available. Results A total of 1,095 patients (72±11.8 years old, 69.7% male), were followed for a median [IQR] of 437 [182; 739] days with a mean adherence to the remote monitoring system of 67.6±30.3%. Over this period, 198 (18.1%) patients had 949 WHF events, the majority of whom were remotely detected: 830 (87.5%). Overall, 246 (26%) of the WHF episodes required hospitalisation and 109 (11%) prompted an emergency department visit. When the WHF event was remotely detected, hospitalization was only required in 127 (15%) cases and the rate of emergency department visit was reduced to 3%. Conclusion In HF patients engaged in a multiparametric remote management program, the rate of emergency department admission is very low. Adopting such a strategy for patients with chronic HF may be useful in reducing emergency department overcrowding.Baseline characteristics of patientsPatients course and use of resources

EVALUATION OF AN ALLIED HEALTH PROFESSIONAL PREHABILITATION SERVICE IN NEURO-ONCOLOGY

Abstract AIMS The evidence base for the benefits of prehabilitation in the cancer population is increasing. So far, the focus has been on colorectal, breast and lung cancer sites with no current research into the effects in patients with primary or secondary brain tumours. It is hypothesised that patients with brain cancer would benefit from prehabilitation as current evidence demonstrates the positive effects of exercise, cognitive and language rehabilitation in this patient group. The aim of this project is to demonstrate the feasibility and impact of a two-year prehabilitation pilot service. The service comprises physiotherapy, occupational therapy and speech and language therapy for patients with brain cancer in the pre-operative phase. METHOD A pilot study was carried out at a tertiary UK neurosurgery centre. Patients over the age of 17 with a diagnosis of primary or secondary brain tumour awaiting surgery were eligible for the prehabilitation service. The impact was measured through Length of Stay, Quality of Life (EQ-5D-5L), emergency department attendances and admission rates 90 days post-surgery. RESULTS 128 patients were seen in prehabilitation from 01/11/2022 to 31/01/2024. Length of hospital stay post-surgery was lower for the prehabilitation group (0.9 days with 95% confidence interval) compared to control group. A mean improvement in the EQ-5D-5L Index from pre-operative assessment to post-surgery follow up was demonstrated CONCLUSION This study reveals data demonstrating the benefits of prehabilitaiton for patients with brain tumours. Prehabilitation for this patient group appears to improve clinical outcomes alongside patients’ quality of life. Future directions for the service will focus on expanding the provision to patients with spinal and benign tumours, where this is also a possibility of therapeutic need in the pre and post-operative phase.

Parental migration, socioeconomic deprivation and hospital admissions in preschool children in England: national birth cohort study, 2008 to 2014

BackgroundA third of children born in England have at least one parent born outside the United Kingdom (UK), yet family migration history is infrequently studied as a social determinant of child health. We describe rates of hospital admissions in children aged up to 5 years by parental migration and socioeconomic group.MethodsBirth registrations linked to Hospital Episode Statistics were used to derive a cohort of 4,174,596 children born in state-funded hospitals in England between 2008 and 2014, with follow-up until age 5 years. We looked at eight maternal regions of birth, maternal country of birth for the 6 most populous groups and parental migration status for the mother and second parent (UK-born/non-UK-born). We used Index of Multiple Deprivation (IMD) quintiles to indicate socioeconomic deprivation. We fitted negative binomial/Poisson regression models to model associations between parental migration groups and the risk of hospital admissions, including interactions with IMD group.ResultsOverall, children whose parents were both born abroad had lower emergency admission rates than children with parents both born in the UK. Children of UK-born (73.6% of the cohort) mothers had the highest rates of emergency admissions (171.6 per 1000 child-years, 95% confidence interval (CI) 171.4–171.9), followed by South Asia-born mothers (155.9 per 1000, 95% CI 155.1–156.7). The high rates estimated in the South Asia group were driven by children of women born in Pakistan (186.8 per 1000, 95% CI 185.4–188.2). A socioeconomic gradient in emergency admissions was present across all maternal regions of birth groups, but most pronounced among children of UK-born mothers (incidence rate ratio 1.43, 95% CI 1.42–1.44, high vs. low IMD group). Patterns of planned admissions followed a similar socioeconomic gradient and were highest among children with mothers born in Middle East and North Africa, and South Asia.ConclusionsOverall, we found the highest emergency admission rates among children of UK-born parents from the most deprived backgrounds. However, patterns differed when decomposing maternal place of birth and admission reason, highlighting the importance of a nuanced approach to research on migration and health.

Evidence-based data support strategies for the prevention of Hymenoptera venom anaphylaxis.

This review aims to identify phenotypes at-risk of Hymenoptera venom-induced anaphylaxis (HVA), focusing on different perspectives (epidemiological, clinical, and therapeutic) in order to adapt future preventive strategies. HVA remains one of the leading causes of anaphylaxis, with a broad pattern of symptoms. Although most cases occur outside healthcare settings, data indicate a high emergency admission rate due to insect stings. Mortality is often underestimated because of the lack of witnesses and difficulties in recognizing the signs and the culprit. Targeting risk factors could be a clue to improve these statistics and the prognosis of the disease.Potential risk factors for severe HVA in the European population are basal serum tryptase (BST) above 8 μg, mast cell disorders, the absence of skin symptoms, and cardiovascular conditions requiring the use of beta blockers and ACE inhibitors. Identifying these criteria, mainly based on clinical patterns, helps to develop personalized strategies for management and prevention. With a personalized medicine approach, phenotypes must be characterized to adapt to the management of patients suffering from Hymenoptera venom anaphylaxis (HVA), including venom immunotherapy (VIT). In this systematic review, all articles mentioned systemic reactions with heterogeneous severity degrees. Half of those reported grade III-IV systemic reactions (Ring and Messmer). HVA clinical patterns could be worsened by one Hymenoptera sting, a patient's history with mast cell disorders, or cardiovascular diseases. VIT failure was attributed to bee venom extract and monotherapy in two-thirds of publications. Findings stress the difficulty of having uniform epidemiological data on HVA and the lack of financial support in some world regions to support appropriate management of these conditions. Although observing a heterogeneity of data, we were able to identify potential risk factors, in particular for the severe cases. We believe our work will support allergists and health professionals to implement improved personalized management of patients suffering from severe HVA.

Are local public expenditure reductions associated with increases in inequality in emergency hospitalisation? Time-series analysis of English local authorities from 2010 to 2017

BackgroundReductions in local government funding implemented in 2010 due to austerity policies have been associated with worsening socioeconomic inequalities in mortality. Less is known about the relationship of these reductions...

Changes in Emergency Department Utilization in Vulnerable Populations After COVID-19 Shelter-in-Place Orders.

This study aims to compare emergency department (ED) utilization and admission rates for patients with a history of mental health (MH) disorders, substance use disorders (SUDs), and social determinants of health (SDOH) before and after implementing COVID-19shelter-in-place (SIP) orders. This was a retrospective, multicenter study leveraging electronic medical record (EMR) data from 20 EDs across a large Midwest integrated healthcare system from 5/2/2019 to 12/31/2019 (pre-SIP) and from 5/2/2020 to 12/31/2020 (post-SIP). Diagnoses were documented in the patient's medical records. Poisson and logistic regression models were used to evaluate ED utilization and admission rate changes. A total of 871,020 ED encounters from 487,028 unique patients were captured. Overall, 2,572 (0.53%) patients had a documented Z code for SDOH. Patients with previously diagnosed MH disorders or SUDs were more likely to seek ED care after the SIP orders were implemented (risk ratio (RR): 1.20, 95% confidence interval (CI): 1.18-1.22, p<0.001), as were patients with SDOH (RR: 2.37, 95% CI: 2.19-2.55, p<0.001). Patients with both previously diagnosed MHdisorders or SUDs and a documented SDOH had even higher ED utilization (RR: 3.31, 95% CI: 2.83-3.88, p<0.001) than those with either condition alone. Patients with MHdisorders and SUDs (OR: 0.89, 95% CI: 0.86-0.92, p<0.001) or SDOH (OR: 0.67, 95% CI: 0.54-0.83, p<0.001) were less likely to be admitted post-SIP orders, while patients with a history of diseases of physiologic systems were more likely to be admitted. Vulnerable populations with a history of MH disorders,SUDs, and SDOH experienced increased ED utilization but a lower rate of hospital admissions after the implementation of SIP orders. The findings highlight the importance of addressing these needs to mitigate the impact of public health crises on these populations.

The Brain Injury Guidelines (BIG) and emergency department observation and admission rates: A retrospective cohort study

BackgroundEmergency Department (ED) Observation Units (OU) can provide safe, effective care for low risk patients with intracranial hemorrhages. We compared current ED OU use for patients with subdural hematomas (SDH) to the validated Brain Injury Guidelines (BIG) to evaluate the potential impact of implementing this risk stratification tool. MethodsRetrospective cohort of patients ≥18 years old with SDH of any cause from 2014 to 2020 to evaluate for potential missed OU cases. Missed OU cases were defined as patients with an initial Glasgow Coma Score (GCS) of 15 with hospital length of stays (LOS) <2 days, who did not meet the composite outcome and were not cared for in the OU or discharged from the ED. Composite outcome included in-hospital death or transition to hospice care, neurosurgical intervention, GCS decline, and worsening SDH size. Secondary outcomes were whether application of BIG would increase ED OU use or reduce CT use. Results264 patients met inclusion criteria over 5.3 year study timeframe. Mean age was 61 years (range 19–93) and 61.4% were male. SDH were traumatic in 76.9% and 60.2% of the cohort had additional injuries. The admission rate was 81.4% (n = 215). Fourteen (6.5%) missed OU cases were identified (2.6/year). Retrospective application of BIG resulted in 82.6% (n = 217) at BIG 3, 10.2% (n = 27) at BIG 2 and 7.6% (n = 20) at BIG 1. Application of BIG would not have decreased admission rates (82.6% BIG 3) and BIG 1 and 2 admissions were often for medical co-morbidities. The composite outcome was met in 50% of BIG 3, 22% of BIG 2, and no BIG 1 patients. ConclusionIn a level 1 trauma center with an established observation unit, current clinical care processes missed very few patients who could be discharged or placed in ED OU for SDH. Hospital admissions in BIG 1/2 were driven by co-morbidities and/or injuries, limiting applicability of BIG to this population.

Abstract 14021: Micra VR Leadless vs. Single-Chamber Transvenous Pacing Outcomes in the Medicare Advantage Population

Introduction: Medicare Advantage (MA) patients are typically healthier and report better outcomes compared to fee-for-service (FFS) Medicare patients. While the benefits of leadless pacing have been demonstrated in the FFS population, no study has evaluated leadless pacemakers in the 100% MA population. Hypothesis: The benefits of leadless pacing extend to the MA patient population. Aims: To compare patient characteristics and outcomes between Micra VR and single-chamber transvenous pacing among MA patients vs. FFS patients. Methods: MA Encounter data was used to identify patients implanted with a Micra VR leadless pacemaker (N=4,970), or a single-chamber transvenous pacemaker (N=6,615) from 2017-2019. Logistic regression was used to compare unadjusted and propensity score overlap weight-adjusted 30-day complication rates. Cox models were used to compare 2-year chronic complications and reinterventions between groups. MA results were compared to results of the Micra Coverage with Evidence Development (CED) study of FFS patients. Results: MA Micra VR patients had a higher comorbidity burden (mean Charlson Comorbidity Index (CCI) 5.3 vs. 4.9, P&lt;0.001) and higher rates of end-stage renal disease (ESRD) (7.3% vs. 1.5%, P&lt;0.001) compared to transvenous patients. After adjusting for patient differences, Micra VR patients had similar rates of acute complications at 30 days (adj. 7.0% vs. 6.8%, P=0.76). At 2 years, Micra VR patients had significantly lower adjusted rates of chronic complications (adj. HR 0.75, 95% CI: 0.61-0.91, P&lt;0.001) and reinterventions (adj. HR 0.57, 95% CI: 0.44-0.75, P&lt;0.001) and there was no difference in adjusted all-cause mortality (adj. HR 1.05, 95% CI: 0.97, 1.14, P=0.26). Compared to FFS patients, MA patients had lower rates of ESRD (7.3% vs. 12.0%) and lower rates of emergency admission (5.4% vs. 12.0%), though their overall comorbidity burden was similar (mean CCI 5.3 vs. 5.1). The comparative benefits compared to transvenous were similar in magnitude in the MA vs. FFS populations. Conclusion: Compared to transvenous pacing, MA patients treated with a Micra VR leadless pacemaker had reductions in chronic complications and reinterventions at 2 years of similar magnitude to those observed in the Medicare FFS population.

Abstract 14011: Micra AV Leadless vs. Dual-Chamber Transvenous Pacing Outcomes Among Patients With End-Stage Renal Disease in the Medicare Population

Introduction: Leadless pacing is often considered a useful alternative for patients with end-stage renal disease (ESRD) due to their limited vascular access and high infection risk. However, there is limited evidence on the comparative outcomes of leadless pacing vs. transvenous pacing in this population. Hypothesis: The reduction in complications and reinterventions associated with leadless pacing in the broader population extends to patients with ESRD. Aims: To compare complications and reinterventions between ESRD patients implanted with a Micra AV leadless pacemaker vs. a dual-chamber transvenous pacemaker. Methods: Data from the Micra Coverage with Evidence Development (CED) Study were used to identify ESRD patients implanted with a Micra AV leadless pacemaker (N=1,116), or a dual-chamber transvenous pacemaker (N=2,163) between February 5, 2020 and December 1, 2021 in the Medicare population. Logistic regression was used to compare unadjusted and propensity score overlap weight-adjusted 30-day acute complication rates. Cox models were used to compare 6-month chronic complications and reinterventions between groups. Results: ESRD patients implanted with Micra AV had a higher overall comorbidity burden (mean Charlson Comorbidity Index 7.9 vs. 7.6, P=0.001) and higher rates of emergency admission (18.6% vs. 14.0%, P=0.001). Despite these differences, there was no difference in the rate of complications at 30 days (unadj. 13.9% vs. 13.8%, P=0.92; adj. 12.9% vs. 14.6%, P=0.20). At 6 months, Micra AV patients had significantly lower rates of chronic complications (unadj. HR 0.72, 95% CI: 0.54-0.96, P=0.02; adj. HR 0.64, 95% CI: 0.48-0.87, P=0.004) and reinterventions (unadj. HR 0.50, 95% CI: 0.29-0.86, P=0.01; adj. HR 0.53, 95% CI: 0.30-0.91, P=0.02) (figure) . Conclusion: In patients with ESRD, AV synchronous leadless pacing is associated with lower rates of complications and need for reintervention compared to dual-chamber transvenous pacing.

Factors associated with emergency admission for people dying from cancer in Northern Ireland: an observational data linkage study

BackgroundMany people living with cancer are admitted as an emergency, some just prior to diagnosis and others in their last year of life. Factors associated with accessing emergency care for people dying of cancer are complex and not well understood. This can make it difficult to have the resources and staffing in place to best care for individuals in their last year of life and their families.MethodsThis study uses routinely collected administrative data from people who died of cancer in N. Ireland (NI) during 2015 and explores how personal characteristics (e.g., gender, age) and disease related factors (e.g., tumour site, cancer stage at initial diagnosis) were associated with having an emergency admission to hospital in the last year and the last 28 days of their lives, using multivariate logistic regression.ResultsAlmost three in four people had at least one emergency admission in the last year of life, and over one in three had an emergency admission the last 28 days of life. Patterns were similar for both time outcomes with males, people with haematological, lung or brain cancers, younger persons, those diagnosed with late-stage cancer, and people diagnosed close to time of death, being significantly more likely to have an emergency admission. While there was no significant association between deprivation and emergency admission rates, those living in urban areas were more likely to have an emergency admission in their last month of life compared to rural dwellers. Late diagnosis was evident with 538 people (12.8% of all deaths from cancer) being diagnosed within one month of death and 1242 (29%) within 3 months of death.ConclusionThe high level of emergency admissions points to gaps in routine end-of-life care, and the need for additional training for hospital staff including frontline emergency department (ED) staff who are often the ‘gatekeepers’ to emergency inpatient care for people living with cancer. The levels of late diagnosis indicate a need for increased population awareness of cancer symptoms and system change to promote earlier diagnosis.

The Long-Term Impacts of an Integrated Care Programme on Hospital Utilisation among Older Adults in the South of England: A Synthetic Control Study.

Reducing hospital use is often viewed as a possible positive consequence of introducing integrated care (IC). We investigated the impact of an IC programme in North East Hampshire and Farnham (NEHF), in southern England, on hospital utilisation among older adults over a 55 months period. We used a Generalised Synthetic Control design to investigate the effect of implementing IC in NEHF between 2015 and 2020. For a range of hospital use outcomes, we estimated the trajectory that each would have followed in the absence of IC and compared it with the actual trajectory to estimate the potential impact of IC. Three years into the programme, emergency admission rates started reducing in NEHF relative to its synthetic control, particularly those resulting in overnight hospital stays. By year 5 of the study overall emergency admission rates were 9.8% lower (95% confidence interval: -17.2% to -0.6%). We found no sustained difference in rates of emergency department (ED) visits, and average length of hospital stay was significantly higher from year 2. An IC programme in NEHF led to lower than estimated emergency admission rates; however, the interpretation of the impact of IC on admissions is complicated as lower rates did not appear until three years into the programme and the reliability of the synthetic control weakens over a long time horizon. There was no sustained change in ED visit rates.

Emergency Department Use Across Income Groups Following an Increase in Cost-Sharing

To encourage the appropriate utilization of emergency care, cost-sharing for emergency care was increased from HK$100 (US $12.8) to HK$180 (US $23.1) per visit in June 2017 in all public hospitals in Hong Kong. However, there are concerns that this increase could deter appropriate emergency department (ED) visits and be associated with income-related disparities. To examine changes in ED visits after the fee increase. This retrospective cohort study used administrative data from June 2015 to May 2019 from all public hospitals in Hong Kong. Participants included all Hong Kong residents aged 64 years and younger, categorized into low-income, middle-income, and high-income groups according to the median household income in their district of residence. Data analysis was performed from May to June 2023. The primary outcome was the ED visit rate per 100 000 people per month, categorized into 3 severity levels (emergency, urgent, and nonurgent). Secondary outcomes include general outpatient (GOP) visit rate, emergency admission rate, and in-hospital mortality rate per month at public hospitals. Segmented regression analyses were used to estimate changes in the level and slope of outcome variables before and after the fee increase. This study included a total of 5 441 679 ED patients (2 606 332 male patients [47.9%]; 2 108 933 patients [38.5%] aged 45-64 years), with 2 930 662 patients (1 407 885 male patients [48.0%]; 1 111 804 patients [37.9%] aged 45-64 years) from the period before the fee increase. The fee increase was associated with an 8.0% (95% CI, 7.1%-9.0%) immediate reduction in ED visits after June 2017, including a 5.9% (95% CI, 3.3%-8.5%) reduction in urgent visits and an 8.9% (95% CI, 8.0%-9.8%) reduction in nonurgent visits. In addition, a 5.7% (95% CI, 4.7%-6.8%) reduction of emergency admissions was found, whereas no significant changes were observed in in-hospital mortality. Specifically, a statistically significant increase in GOP visits (4.1%; 95% CI, 0.9%-7.2%) was found within the low-income group, but this association became insignificant after controlling for the social security group, who were exempted from payment, as a control. In this cohort study, the fee increase was not associated with changes in ED visits for emergency conditions, but there was a negative and significant association with both urgent and nonurgent conditions across all income groups. Considering the marginal increase in public GOP services, further study is warranted to examine strategies to protect low-income people from avoiding necessary care.

Multicentre, interventional, single-arm study protocol of telemonitored circadian rhythms and patient-reported outcomes for improving mFOLFIRINOX safety in patients with pancreatic cancer (MultiDom, NCT04263948)

IntroductionCircadian clocks regulate cellular proliferation and drug effects. Tolerability and/or efficacy of anticancer therapies have been improved by their administration according to circadian rhythms, while being predicted by circadian robustness....

A novel physiotherapy-led prehabilitation service: an evaluation

Background: Prehabilitation has been shown to improve functional capacity.1 This has been demonstrated to reduce postoperative complications, hospital length of stay, and emergency admission rates.2 There is currently poor evidence on the effect on health-related quality of life.3 Methods: In 2019, University Hospitals Bristol and Weston (UHBW) set up a physiotherapy-led prehabilitation service to those listed for major surgery. Initial assessments are predominantly carried out face to face, in surgical clinics. Assessment includes screening for physical, nutritional, and psychological risk factors. Personalised exercise programmes, targeted nutritional, smoking, alcohol, and wellbeing support are provided. Follow-ups are predominately conducted over the phone on a weekly basis. Outcome measures are completed at the start and end of prehabilitation intervention. These include, 30-s sit to stand test, grip strength, and EQ5D-5L. This aims to measure overall strength, functional capacity, and health-related quality of life. Here we look at change in score from start to end of prehabilitation. Results: A total of 795 patients (average age 67 yr) have been enrolled in our prehabilitation programme in a 20-month period. Surgical specialities include: colorectal, thoracic, upper gastrointestinal, hepatobiliary, and head and neck. Data show a significant improvement in 30-s sit to stand score, average difference +2.89 (P<0.01) n=305 (Fig. 10) and a significant improvement in EQ5D index score, +0.048 (P<0.01) n=325. There was no improvement in grip strength, average difference + 0.39 kg (P=0.420) n=99. Conclusion: A personalised physiotherapy-led prehabilitation programme can improve functional capacity and health-related quality of life in patients before major surgery. Expansion of the service includes identifying patients earlier in the pathway, providing nicotine replacement therapy, and setting up group exercise classes. 1.Minnella E, Bousquet-Dion G, Awasthi R, Scheede-Bergdahl C, Carli F. Acta Oncologica 2017; 56: 295–3002.NHS South, Central and West Commissioning Support Unit. Prehad4Cancer Evaluation. 2022 (available from https://www.prehab4cancer.co.uk/wp-content/uploads/2022/01/GM_Prehab4Cancer_Evaluation_Report_Final-003.pdf (accessed 20/03/23)3.Scriney A, Russell A, Loughney L, Gallagher P, Boran L. Psychooncology 2022; 31: 2050–62

Comparing inpatient management of chronic pelvic pain flares before and after the COVID-19 pandemic.

Patients with chronic pelvic pain (CPP) may experience pain exacerbations requiring hospital admissions. Due to the effects of backlogged elective surgeries and outpatient gynaecology appointments resulting from the COVID-19 pandemic, we hypothesised that there would be an increased number of women admitted with CPP flares. We conducted a retrospective review of all acute gynaecology admissions at the Royal Infirmary of Edinburgh from July to December 2018 (pre-COVID) and 2021 (post-COVID lockdown). We collected information on the proportion of emergency admissions due to CPP, inpatient investigations and subsequent management. Average total indicative hospital inpatient costs for women with CPP were calculated using NHS National Cost Collection data guidance. There was no significant difference in the number of emergency admissions due to pelvic pain before (153/507) and after (160/461) the COVID-19 pandemic. As high as 33 and 31% had a background history of CPP, respectively. Across both timepoints, investigations in women with CPP had low diagnostic yield: <25% had abnormal imaging findings and 0% had positive vaginal swab cultures. Women with CPP received significantly more inpatient morphine, pain team reviews and were more likely to be discharged with strong opioids. Total yearly inpatient costs were £170,104 and £179,156 in 2018 and 2021, respectively. Overall, emergency admission rates for managing CPP flares was similar before and after the COVID-19 pandemic. Inpatient resource use for women with CPP remains high, investigations have low diagnostic yield and frequent instigation of opiates on discharge may risk dependence. Improved community care of CPP is needed to reduce emergency gynaecology resource utilisation. Existing treatments for chronic pelvic pain (CPP) and endometriosis focus on surgery or hormone medication, but these are often ineffective or associated with unacceptable side-effects. As a result, women continue to experience chronic pain and often have 'flares' of worsening pain that may lead to hospital admission. The COVID-19 pandemic resulted in backlogged gynaecology clinics and surgeries. The aim of this study was to compare the management of emergency pelvic pain admissions for women with CPP before and after COVID-19. We also aimed to better understand their in-hospital management and estimate their hospital length of stay costs. We did not find an increase in CPP patients admitted for pelvic pain flares after the COVID-19 lockdown. Women with CPP often undergo multiple hospital tests and are often prescribed with strong pain medications which can cause long-term problems. Efforts are needed to improve long-term pain management for women with CPP.

Retrospective Analysis to Assess the Admission Rate Trends in an Irish Public Hospital between February 2014-September 2022

Introduction:As the population in the Republic of Ireland increases, the number of Emergency Department (ED) attendances and admission rates increase, placing significant pressure on the health care system, the limited staff and hospital resources.The aim of this study is to assess the admission rates in an Irish Public Hospital Emergency Department between 2014 and 2022.Method:This retrospective study was done using information provided by the Health Service Executive Integrated Patient Management System. Data for the period between February 2014 to September 2022 were collected. From the data, the admission rate can be calculated and trends observed.Results:Emergency department attendance rates have increased from 29,236 to 42,637 between 2014 and 2019, with a decline noticed in 2020 to 37,751 and a drastic increase in 2021 at 43,182. Currently up until September 2022 there has been 35,503 attendances and 8,570 admissions, with an admission rate of 24.14%. The number of admissions has ranged from 9,056 in 2014 to the highest being 12,175 in 2019. This means the admission rate is averaging between 24% to 31% per annum, with the highest being 31,04% in 2015, and the lowest in 2017 at 24,99%.Conclusion:This study showed a steady increase in attendances per annum, which correlates to an increase in the total admissions from 2014 to 2022, with approximately one third of all ED attendances resulting in admission. The increase in attendances and admission rate could be related to the population growth from 4.6 to 5.1 million from 2014 to 2022. The decrease in attendances during 2020 could be attributed to the Covid-19 pandemic restrictions being implemented, and lifted in 2021 which showed a drastic increase in ED numbers. Ultimately, the increase in admissions will place a burden on the Public Hospitals in Ireland.

Spatiotemporal Modeling of the Association between Neighborhood Factors and COVID-19 Incidence Rates in Scotland

This study aims to investigate the association between neighborhood-level factors and COVID-19 incidence in Scotland from a spatiotemporal perspective. The outcome variable is the COVID-19 incidence in Scotland. Based on the identification of the wave peaks for COVID-19 cases between 2020 and 2021, confirmed COVID-19 cases in Scotland can be divided into four phases. To model the COVID-19 incidence, sixteen neighborhood factors are chosen as the predictors. Geographical random forest models are used to examine spatiotemporal variation in major determinants of COVID-19 incidence. The spatial analysis indicates that proportion of religious people is the most strongly associated with COVID-19 incidence in southern Scotland, whereas particulate matter is the most strongly associated with COVID-19 incidence in northern Scotland. Also, crowded households, prepandemic emergency admission rates, and health and social workers are the most strongly associated with COVID-19 incidence in eastern and central Scotland, respectively. A possible explanation is that the association between predictors and COVID-19 incidence might be influenced by local context (e.g., people’s lifestyles), which is spatially variant across Scotland. The temporal analysis indicates that dominant factors associated with COVID-19 incidence also vary across different phases, suggesting that pandemic-related policy should take spatiotemporal variations into account.

Improving diabetes care in Ealing, London: an analysis of the NDA and diabetes‐related admissions data during first year of COVID‐19

AbstractIn this paper, we present and analyse National Diabetes Audit (NDA) and diabetes‐related emergency admissions data in Ealing during the period 1 January 2020 to 31 March 2021. Care for diabetes and other long‐term conditions was disrupted and significantly impacted during this initial period of the COVID‐19 pandemic.The NDA analysis shows that for type 1 and type 2 diabetes Key Care Processes (KCPs), both the eight and nine KCPs fell between 2019/20 and 2020/21, but the relative fall for NHS Ealing was lower than that seen for England. Type 1 diabetes Three Treatment Targets (3TTs) for NHS Ealing increased from 22.6% in 2019/20 to 26.4% in 2020/21; in contrast the 3TTs for England increased slightly from 19.8% in 2019/20 to 20.8% in 2020/21. Type 2 diabetes 3TTs for NHS Ealing changed from 40.9% in 2019/20 to 38.9% in 2020/21, while in England it was 40.3% in 2019/20 and 35.5% in 2020/21.The diabetes‐related emergency admissions analysis shows that there were reductions in the number and rate of emergency admissions for cerebrovascular accident and myocardial infarction; admissions and rates for diabetic ketoacidosis and amputations were the same; those for diabetes mellitus and hypoglycaemia increased. There were overall cost savings of £874,147 due to estimated avoided admissions.In Ealing, the NDA data, diabetes‐related emergency admissions and estimated avoided admissions data show that improvements in diabetes care achieved in previous years in Ealing, faltered, but were broadly sustained in the first pandemic year. Support from the Ealing diabetes care teams, improved self‐management of diabetes and the empowering of people with diabetes through digital technologies could explain these trends in Ealing. Continued access to health care practitioners during the COVID‐19 pandemic is important to ensure the appropriate management of long‐term conditions such as type 1 diabetes mellitus and type 2 diabetes mellitus. Copyright © 2023 John Wiley &amp; Sons.

Healthcare use by children in North West London 2015-2019 by deprivation and integrated care access

Abstract Background England has a health system offering universal coverage, but disparities in healthcare use are increasing. Between 2007-2017, children living in more deprived areas had higher rates of unplanned care (Emergency Department (ED) attendance and hospital admissions), whereas children from less deprived areas had higher rates of planned care (General Practitioner (GP) contact and outpatient appointments). More detailed research to find solutions for this divergent pattern is required. Aim To assess the rates of GP contact, outpatient appointments, hospital admissions and ED attendance in North West London, by Index of Multiple Deprivation (IMD) decile of home postcode and access to an integrated care service providing linked care between multiple child health professionals ‘Connecting Care for Children (CC4C)', for children aged 0-18 years between 2015-2019. Methods Retrospective analysis of a de-identified database of integrated care records for 495,357 children. Results Children from the most deprived decile had higher rates of emergency admissions (0.070 per child per year vs. overall mean 0.040), elective admissions (0.076 vs. 0.032), ED attendances (0.754 vs. 0.358) and outpatient appointments (1.702 vs. 0.756) between 01.01.2015- 31.12.2019. Children from the least deprived decile had the second highest rates of outpatient appointments (0.911 vs. 0.756) and GP contact (8.192 vs. 5.390) between 01.01.2015- 31.12.2019. Children with access to the CC4C service, despite being from more deprived backgrounds, had lower rates of emergency admissions (0.028 vs. 0.037) compared to patients with access to usual care. P values &amp;lt;0.001 in all cases. Conclusions Greater deprivation was linked to higher rates of emergency admissions, but this was partially mitigated by access to more integrated healthcare models. Children from the least deprived decile continued to have disproportionately higher use of planned care. Key messages • Despite universal health coverage, children from more deprived areas continue to have disproportionately higher use of unplanned care. • Further research is required to explore whether integrated care solutions can reduce the burden on unplanned health services and inequalities in access to care.