Emergency Admissions In England Research Articles

The Liverpool alcohol-related liver disease algorithm identifies twice as many emergency admissions compared to standard methods when applied to Hospital Episode Statistics for England.

Emergency admissions in England for alcohol-related liver disease (ArLD) have increased steadily for decades. Statistics based on administrative data typically focus on the ArLD-specific code as the primary diagnosis and are therefore at risk of excluding ArLD admissions defined by other coding combinations. To deploy the Liverpool ArLD Algorithm (LAA), which accounts for alternative coding patterns (e.g., ArLD secondary diagnosis with alcohol/liver-related primary diagnosis), to national and local datasets in the context of studying trends in ArLD admissions before and during the COVID-19 pandemic. We applied the standard approach and LAA to Hospital Episode Statistics for England (2013-21). The algorithm was also deployed at 28 hospitals to discharge coding for emergency admissions during a common 7-day period in 2019 and 2020, in which eligible patient records were reviewed manually to verify the diagnosis and extract data. Nationally, LAA identified approximately 100% more monthly emergency admissions from 2013 to 2021 than the standard method. The annual number of ArLD-specific admissions increased by 30.4%. Of 39,667 admissions in 2020/21, only 19,949 were identified with standard approach, an estimated admission cost of £70 million in under-recorded cases. Within 28 local hospital datasets, 233 admissions were identified using the standard approach and a further 250 locally verified cases using the LAA (107% uplift). There was an 18% absolute increase in ArLD admissions in the seven-day evaluation period in 2020 versus 2019. There were no differences in disease severity or mortality, or in the proportion of admissions with decompensation of cirrhosis or alcoholic hepatitis. The LAA can be applied successfully to local and national datasets. It consistently identifies approximately 100% more cases than the standard coding approach. The algorithm has revealed the true extent of ArLD admissions. The pandemic has compounded a long-term rise in ArLD admissions and mortality.

Trends and characteristics of hospitalisations from the harmful use of opioids in England between 2008 and 2018: Population-based retrospective cohort study.

SummaryObjectiveTo examine the trends and characteristics of opioid-related hospital admissions in England over 10 years, and its burden for the National Health Service and public finances.DesignPatient-level data from the Hospital Episode Statistics database to examine all opioid-related hospitalisations from 2008 to 2018, stratified by type of opioid admission and patient demographics.SettingAll National Health Service hospitals in England.ParticipantsPatients hospitalised from the harmful use of opioids.Main outcome measuresThe number of opioid-related hospitalisations, length of stay, in-hospital mortality, 30-day readmission rate and treatment costs.ResultsOpioid-related hospitalisations increased by 48.9%, from 10,805 admissions in 2008 to 16,091 admissions in 2018, with total treatment costs of £137 million. The growth in opioid-related hospitalisations was 21% above the corresponding rate for all other emergency admissions in England. Relative changes showed that hospitalisations increased most for individuals older than 55 years (160%), those living in the most affluent areas of England (93.8%), and suffering from four co-morbidities (627.6%) or more. Hospitals reduced mean patient length of stay from 2.8 days to 1.1 days over 10 years. Mean in-hospital mortality was 0.4% and mean 30-day readmission risk was 16.6%.ConclusionOpioid use is an increasing public health concern in England, though hospitalisation and mortality rates are less pronounced than in other countries. There are concerns about significant rises in hospitalisations from older, less deprived and sicker population groups. Our findings should prompt policymakers to go beyond monitoring mortality statistics when assessing the impacts of harmful use of opioids.

The outcomes of emergency hospital admissions with non-malignant upper gastrointestinal bleeding in England between 2003 and 2015.

Upper gastrointestinal bleeding (UGIB) is a common medical emergency with significant mortality. Despite developments in endoscopic and clinical management, only minor improvements in outcomes have been reported. This was a retrospective cohort study of patients with non-malignant UGIB emergency admissions in England between 2003 and 2015, using Hospital Episode Statistics. Multilevel logistic regression analysis examined the associations with mortality. 242 796 patients with an UGIB admission were identified (58.8 % men; median age 70 [interquartile range (IQR) 53 - 81]). Between 2003 and 2015, falls occurred in both 30-day mortality (7.5 % to 7.0 %; P < 0.001) and age-standardized mortality (odds ratio (OR) 0.74, 95 % confidence interval [CI] 0.69 - 0.80; P < 0.001), including from variceal bleeding (OR 0.63, 95 %CI 0.45 - 0.87; P < 0.005). Increasing co-morbidity (Charlson score > 5, OR 2.94, 95 %CI 2.85 - 3.04; P < 0.001), older age (> 83 years, OR 6.50, 95 %CI 6.09 - 6.94; P < 0.001), variceal bleeding (OR 2.03, 95 %CI 1.89 - 2.18; P < 0.001), and a weekend admission (Sunday, OR 1.18, 95 %CI 1.12 - 1.23; P < 0.001) were associated with 30-day mortality. Of deaths at 30 days, 8.9 % were from ischemic heart disease (IHD) and the cardiovascular age-standardized mortality rate following UGIB was high (IHD deaths within 1 year, 1188.4 [95 %CI 1036.8 - 1353.8] per 100 000 men in 2003). Between 2003 and 2015, 30-day mortality among emergency admissions with non-malignant UGIB fell by 0.5 % to 7.0 %. Mortality was higher among UGIB admissions at the weekend, with important implications for service provision. Patients with UGIB had a much greater risk of subsequently dying from cardiovascular disease and addressing this risk is a key management step in UGIB.

Multimorbidity combinations, costs of hospital care and potentially preventable emergency admissions in England: A cohort study.

Patients with multimorbidities have the greatest healthcare needs and generate the highest expenditure in the health system. There is an increasing focus on identifying specific disease combinations for addressing poor outcomes. Existing research has identified a small number of prevalent "clusters" in the general population, but the limited number examined might oversimplify the problem and these may not be the ones associated with important outcomes. Combinations with the highest (potentially preventable) secondary care costs may reveal priority targets for intervention or prevention. We aimed to examine the potential of defining multimorbidity clusters for impacting secondary care costs. We used national, Hospital Episode Statistics, data from all hospital admissions in England from 2017/2018 (cohort of over 8 million patients) and defined multimorbidity based on ICD-10 codes for 28 chronic conditions (we backfilled conditions from 2009/2010 to address potential undercoding). We identified the combinations of multimorbidity which contributed to the highest total current and previous 5-year costs of secondary care and costs of potentially preventable emergency hospital admissions in aggregate and per patient. We examined the distribution of costs across unique disease combinations to test the potential of the cluster approach for targeting interventions at high costs. We then estimated the overlap between the unique combinations to test potential of the cluster approach for targeting prevention of accumulated disease. We examined variability in the ranks and distributions across age (over/under 65) and deprivation (area level, deciles) subgroups and sensitivity to considering a smaller number of diseases. There were 8,440,133 unique patients in our sample, over 4 million (53.1%) were female, and over 3 million (37.7%) were aged over 65 years. No clear "high cost" combinations of multimorbidity emerged as possible targets for intervention. Over 2 million (31.6%) patients had 63,124 unique combinations of multimorbidity, each contributing a small fraction (maximum 3.2%) to current-year or 5-year secondary care costs. Highest total cost combinations tended to have fewer conditions (dyads/triads, most including hypertension) affecting a relatively large population. This contrasted with the combinations that generated the highest cost for individual patients, which were complex sets of many (6+) conditions affecting fewer persons. However, all combinations containing chronic kidney disease and hypertension, or diabetes and hypertension, made up a significant proportion of total secondary care costs, and all combinations containing chronic heart failure, chronic kidney disease, and hypertension had the highest proportion of preventable emergency admission costs, which might offer priority targets for prevention of disease accumulation. The results varied little between age and deprivation subgroups and sensitivity analyses. Key limitations include availability of data only from hospitals and reliance on hospital coding of health conditions. Our findings indicate that there are no clear multimorbidity combinations for a cluster-targeted intervention approach to reduce secondary care costs. The role of risk-stratification and focus on individual high-cost patients with interventions is particularly questionable for this aim. However, if aetiology is favourable for preventing further disease, the cluster approach might be useful for targeting disease prevention efforts with potential for cost-savings in secondary care.

Modelling the impact of the mandatory use of face coverings on public transport and in retail outlets in the UK on COVID-19-related infections, hospital admissions and mortality.

IntroductionThe rapid spread of the pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2/)(COVID‐19) virus resulted in governments around the world instigating a range of measures, including mandating the wearing of face coverings on public transport/in retail outlets.MethodsWe developed a sequential assessment of the risk reduction provided by face coverings using a step‐by‐step approach. The UK Office of National Statistics (ONS) Population Survey data were utilised to determine the baseline total number of community‐derived infections. These were linked to reported hospital admissions/hospital deaths to create case admission risk ratio and admission‐related fatality rate. We evaluated published evidence to establish an infection risk reduction for face coverings. We calculated an Infection Risk Score (IRS) for a number of common activities and related it to the effectiveness of reducing infection and its consequences, with a face covering, and evaluated their effect when applied to different infection rates over 3 months from July 24, 2020, when face coverings were made compulsory in England on public transport/retail outlets.ResultsWe show that only 7.3% of all community‐based infection risk is associated with public transport/retail outlets. In the week of July 24, The reported weekly community infection rate was 29 400 new cases at the start (July 24). The rate of growth in hospital admissions and deaths for England was around −15%/week, suggesting the infection rate, R, in the most vulnerable populations was just above 0.8. In this situation, average infections over the evaluated 13 week follow‐up period, would be 9517/week with face covering of 40% effectiveness, thus, reducing average infections by 844/week, hospital admissions by 8/week and deaths by 0.6/week; a fall of 9% over the period total. If, however, the R‐value rises to 1.0, then, average community infections would stay at 29 400/week and mandatory face coverings could reduce average weekly infections by 3930, hospital admissions by 36 and deaths by 2.9/week; a 13% reduction.If the R‐value rose and stayed at 1.2, then, expected average community‐derived hospital admissions would be 975/week and 40% effective face coverings would reduce this by 167/week and reduce possible expected hospital deaths from 80/week to 66/week.These reductions should be seen in the context that there was an average of 102 000/week all‐cause hospital emergency admissions in England in June and 8900 total reported deaths in the week ending August 7, 2020.ConclusionWe have illustrated that the policy on mandatory use of face coverings in retail outlets/on public transport may have been very well followed, but may be of limited value in reducing hospital admissions and deaths, at least at the time that it was introduced, unless infections begin to rise faster than currently seen. The impact appears small compared with all other sources of risk, thereby raising questions regarding the effectiveness of the policy.

The effect of extreme temperature on emergency admissions across vulnerable populations in England: an observational study

BackgroundClimate change poses an unfamiliar challenge to population health and health-systems resilience. Although previous studies have estimated morbidity attributable to heat or cold across cities, we provide, to our knowledge, the first large-scale, population-wide assessment of the effect of extreme temperatures on excess emergency admissions in England and among vulnerable populations, who could be disproportionately affected. MethodsIn this observational study, we combined all daily inpatient admissions during 2001–12 in England with meteorological data using inverse distance weighting. We exploited random daily variation in temperature experienced by hospitals and a 30-day lag period, using a distributed lag model with multiple fixed-effects controlling for seasonal factors, to examine interaction effects across diseases with age and the indices of multiple deprivation. FindingsWe analysed 29 371 084 emergency admissions. A day with temperature above 30°C was associated with 3·5 more admissions per hospital (SE 0·45), relative to a 10–15°C day. This increased to 14·1 excess admissions per hospital (SE 5·56) over the following 30 days, generating 786 excess admissions across England per heatwave day. A day under –5°C generated 3·8 more admissions per hospital (SE 0·33), or 966 excess admissions across England. This increased to 62·3 admissions per hospital (SE 4·83) over the following 30 days. These effects were heterogeneous across age and deprivation level. Populations older than 74 years were up to 8 times more affected by extreme temperatures. Individuals living in low-employment and low-income areas were 2–10 times more likely to be admitted during a temperature shock. These results were statistically significant (p<0·0001) and passed several robustness and falsification tests. InterpretationTo our knowledge, this is the first study to determine heterogeneous morbidity risks of temperature across an entire population using a robust, near-causal methodology. Population health is negatively affected by hot and cold temperature shocks, with older people and those living in low-employment and low-income areas disproportionately affected. Findings were unadjusted for pollution and possible individual protective behaviours, providing underestimated—yet policy-applicable—risks of temperature. A heterogeneous lag effect indicates the importance of considering vulnerable populations in policy making to ensure mitigation and resilience policies are not restricted to immediate temperature shocks only and are sensitive to vulnerable populations, mitigating inequalities in access to health care. FundingBritish Academy and Imperial College Business School.

Health equity monitoring for healthcare quality assurance

Population-wide health equity monitoring remains isolated from mainstream healthcare quality assurance. As a result, healthcare organizations remain ill-informed about the health equity impacts of their decisions – despite becoming increasingly well-informed about quality of care for the average patient. We present a new and improved analytical approach to integrating health equity into mainstream healthcare quality assurance, illustrate how this approach has been applied in the English National Health Service, and discuss how it could be applied in other countries. We illustrate the approach using a key quality indicator that is widely used to assess how well healthcare is co-ordinated between primary, community and acute settings: emergency inpatient hospital admissions for ambulatory care sensitive chronic conditions (“potentially avoidable emergency admissions”, for short). Whole-population data for 2015 on potentially avoidable emergency admissions in England were linked with neighborhood deprivation indices. Inequality within the populations served by 209 clinical commissioning groups (CCGs: care purchasing organizations with mean population 272,000) was compared against two benchmarks – national inequality and inequality within ten similar populations – using neighborhood-level models to simulate the gap in indirectly standardized admissions between most and least deprived neighborhoods. The modelled inequality gap for England was 927 potentially avoidable emergency admissions per 100,000 people, implying 263,894 excess hospitalizations associated with inequality. Against this national benchmark, 17% of CCGs had significantly worse-than-benchmark equity, and 23% significantly better. The corresponding figures were 11% and 12% respectively against the similar populations benchmark. Deprivation-related inequality in potentially avoidable emergency admissions varies substantially between English CCGs serving similar populations, beyond expected statistical variation. Administrative data on inequality in healthcare quality within similar populations served by different healthcare organizations can provide useful information for healthcare quality assurance.

Story in numbers.

Attendances and emergency admissions in England.

Compression of the Internal Carotid Artery by Turning the Head to the Left

2 Sinha S, Karthikesalingam A, Poloniecki JD, Thompson MM, Holt PJ. Inter-relationship of procedural mortality rates in vascular surgery in England: retrospective analysis of hospital episode statistics from 2005 to 2010. Circ Cardiovasc Qual Outcomes 2014;7(1):131e41. 3 Holt PJ, Sinha S, Ozdemir BA, Karthikesalingam A, Poloniecki JD, Thompson MM. Variations and inter-relationship in outcome from emergency admissions in England: a retrospective analysis of hospital episode statistics from 2005e2010. BMC Health Serv Res 2014;14:270. 4 Sinha S, Ata Ozdemir B, Khalid U, Karthikesalingam A, Poloniecki JD, Thompson MM, et al. Failure-to-rescue and inter-

Variations and inter-relationship in outcome from emergency admissions in England: a retrospective analysis of Hospital Episode Statistics from 2005-2010.

BackgroundThe quality of care delivered and clinical outcomes of care are of paramount importance. Wide variations in the outcome of emergency care have been suggested, but the scale of variation, and the way in which outcomes are inter-related are poorly defined and are critical to understand how best to improve services. This study quantifies the scale of variation in three outcomes for a contemporary cohort of patients undergoing emergency medical and surgical admissions. The way in which the outcomes of different diagnoses relate to each other is investigated.MethodsA retrospective study using the English Hospital Episode Statistics 2005–2010 with one-year follow-up for all patients with one of 20 of the commonest and highest-risk emergency medical or surgical conditions. The primary outcome was in-hospital all-cause risk-standardised mortality rate (in-RSMR). Secondary outcomes were 1-year all-cause risk-standardised mortality rate (1 yr-RSMR) and 28-day all-cause emergency readmission rate (RSRR).Results2,406,709 adult patients underwent emergency medical or surgical admissions in the groups of interest. Clinically and statistically significant variations in outcome were observed between providers for all three outcomes (p < 0.001). For some diagnoses including heart failure, acute myocardial infarction, stroke and fractured neck of femur, more than 20% of hospitals lay above the upper 95% control limit and were statistical outliers. The risk-standardised outcomes within a given hospital for an individual diagnostic group were significantly associated with the aggregated outcome of the other clinical groups.ConclusionsHospital-level risk-standardised outcomes for emergency admissions across a range of specialties vary considerably and cross traditional speciality boundaries. This suggests that global institutional infra-structure and processes of care influence outcomes. The implications are far reaching, both in terms of investigating performance at individual hospitals and in understanding how hospitals can learn from the best performers to improve outcomes.

What aspects of primary care predict emergency admission rates? A cross sectional study

BackgroundFrom 2004 to 2009 there was almost a 12% rise in emergency admissions in England. This can be explained partly by an aging population and other socio-demographic characteristics, but much cannot be explained by these factors. We explored aspects of care, in addition to known demographic characteristics in general practice, that are associated with emergency admissions.MethodsA cross-sectional design employing hospital admission data from 76 general practices in Northamptonshire, England for 2006–08, including demographic data, quality and outcomes framework points and GP patient survey outcomes.ResultsThere were statistically significant associations between emergency admissions and age, gender, distance from hospital and proportion classified as white. There was also a statistically significant relationship between emergency admissions and being able to book an appointment with a preferred doctor; this relationship was stronger in less deprived communities.ConclusionsEnabling patients to book with a preferred doctor, particularly those in less deprived communities could have an impact on reducing emergency admissions. It is possible that being able to consult a preferred GP gives patient’s confidence to avoid an emergency admission or it facilitates consistent clinical management that helps prevent the need for admission. However the findings only explained some of the variation.

Avoiding inappropriate paediatric admission: facilitating General Practitioner referral to Community Children’s Nursing Teams

BackgroundChildren’s emergency admissions in England are increasing. Community Children’s Nursing Teams (CCNTs) have developed services to manage acutely ill children at home to reduce demand for unscheduled care. Referral between General Practitioners (GPs) and CCNTs may reduce avoidable admissions and minimise the psychosocial and financial impact of hospitalisation on children, families and the NHS. However, facilitators of GP referral to CCNTs are not known. The aim of this study was to identify facilitators of GP referral to CCNTs.MethodsSemi-structured interviews with 39 health professionals were conducted between June 2009 and February 2010 in three Primary Care Trusts served by CCNTs in North West England. Interviewees included GPs, Community Children’s Nurses (CCNs), consultant paediatricians, commissioners, and service managers. Qualitative data were analysed thematically using the Framework approach in NVivo 8.ResultsFive facilitators were identified: 1) CCN/CCNT visibility; 2) clear clinical governance procedures; 3) financial and organisational investment in the role of CCNTs in acute care pathways; 4) access and out of hours availability; 5) facilitative financial frameworks.ConclusionGPs required confidence in CCNs’ competence to safely manage acutely ill children at home and secure rapid referral if a child’s condition deteriorated. Incremental approaches to developing GP referral to CCNTs underpinned by clear clinical governance protocols are likely to be most effective in building GP confidence and avoiding inappropriate admission.

Chronic cardiac chest pain

Complaints of chest discomfort and pain is one of the most common causes of patients seeking help in primary care with 20 –40% of the general population affected by chest pain during their lifetime. The incidence of unspecific chest pain ranges from 10 in the 20 –29 yr old to 30 per 1000 person-years in the 70– 79 yr old, 1 and in any given year, one-fifth of the population will experience chest pain. Although the majority of cases are benign and short lived, with only a minority of patients consulting their doctor, acute new or new-onchronic chest pain still accounts for an estimated 700 000 annual emergency department attendances and a quarter of medical emergency admissions in England and Wales. 2 With 8% of men and 3% of women aged between 55 and 64 and 14% of men and 8% of women aged between 64 and 74 suffering from angina, 3 medical staff will repeatedly encounter patients with chest pain. At the acute presentation, it is important to establish the presence of ischaemic heart disease, such as acute coronary syndrome (ACS), warranting urgent medical or surgical intervention. Whereas treatment of newly diagnosed coronary artery disease (CAD) and angina follows wellestablished medical and surgical pathways, a number of patients with established angina, however, fail to respond to medical therapy or are unsuitable for surgical intervention. Such refractory angina is defined as chronic when lasting more than 3 months. Chronic refractory angina is characterized by reversible myocardial ischaemia in the presence of progressive CAD difficult to control by a combination of medical therapy, percutaneous coronary intervention (PCI), and coronary artery bypass graft surgery (CABG). 4 Additionally, the patients often have impaired left ventricular function, renal impairment, and diabetes. Although it would be anticipated that this group of patients would become even smaller with continued advancements in medical technology, data suggest a continued European yearly incidence of 30–50 000 chronic refractory angina patients. 4 Even after coronary revascularization, surveys suggest between 19% and 38% of the patients remain troubled by angina 12 months after intervention. 5 As some of these patients will present in chronic pain clinics and for noncardiac surgery, anaesthetists will be required to assist in their management.

Principles of safe and timely hospital discharge

British Journal of Hospital MedicineVol. 72, No. Sup8 Clinical PracticePrinciples of safe and timely hospital dischargeRobin H Johns, Ananna Rahman, Sarah Sharp, Carol Back, Ahmed Ishaque, Huw S JenkinsRobin H JohnsSearch for more papers by this author, Ananna RahmanSearch for more papers by this author, Sarah SharpSearch for more papers by this author, Carol BackSearch for more papers by this author, Ahmed IshaqueSearch for more papers by this author, Huw S JenkinsSearch for more papers by this authorRobin H Johns; Ananna Rahman; Sarah Sharp; Carol Back; Ahmed Ishaque; Huw S JenkinsPublished Online:16 Aug 2013https://doi.org/10.12968/hmed.2011.72.Sup8.M120AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Agterof MJ, Schutgens RE, Snijder RJ et al. (2010) Out of hospital treatment of acute pulmonary embolism in patients with a low NT-proBNP level. J Thromb Haemost 8(6): 1235–41 Crossref, Medline, Google ScholarBlunt I, Bardsley M, Dixon J (2010) Trends in Emergency Admissions in England 2004-2009. The Nuffield Trust, London Google ScholarCare Quality Commission (2010) The state of healthcare and adult social care in England. Key themes and quality of services in 2009. Her Majesty's Stationery Office, London Google ScholarCotton MM, Bucknall CE, Dagg KD, Johnson MK, MacGregor G, Stewart C, Stevenson RD (2000) Early discharge for patients with exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial. Thorax 55(11): 902–6 Crossref, Medline, Google ScholarDarzi A (2007) A Framework For Action. Healthcare for London, London Google ScholarDepartment of Health (2003) Discharge from hospital: pathway, process and practice. Department of Health, London Google ScholarDepartment of Health (2009a) Decision Support Tool for NHS Continuing Healthcare. Department of Health, London Google ScholarDepartment of Health (2009b) Fast Track Pathway Tool for NHS Continuing Healthcare. Department of Health, London Google ScholarDepartment of Health (2009c) NHS Continuing Care Checklist. Department of Health, London Google ScholarDepartment of Health (2009d) The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. Department of Health, London Google ScholarDepartment of Health (2010a) Care Services Efficiency Delivery Homecare Re-ablement Toolkit. Intermediate Care and Homecare Re-ablement: What's in a Name? Department of Health, London Google ScholarDepartment of Health (2010b) Equity and excellence: Liberating the NHS. Department of Health, London Google ScholarDepartment of Health (2010c) Prioritising need in the context of Putting People First: A whole system approach to eligibility for social care. Guidance on Eligibility Criteria for Adult Social Care, England 2010. Department of Health, London Google ScholarHarker R (2009) NHS bed availability in England, House of Commons Library, London Google ScholarLeff B, Burton L, Mader S et al. (2006) Satisfaction with hospital at home care. J Am Geriatr Soc 54(9): 1355–63 Crossref, Medline, Google ScholarLim WS, Baudouin SV, George RC et al. (2009) BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax 64(Suppl 3): iii1–55 Crossref, Medline, Google ScholarRoyal College of Nursing (2004) Needs Assessment and Older People. A Royal College of Nursing Toolkit. Royal College of Nursing, London Google Scholar FiguresReferencesRelatedDetailsCited ByInterventions to improve the continuity of medication management upon discharge of patients from hospital to residential aged care facilities16 April 2019 | Journal of Pharmacy Practice and Research, Vol. 49, No. 2 1 August 2011Volume 72Issue Sup8ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 16 August 2013 Published in print 1 August 2011 Information© MA Healthcare LimitedPDF download

Ambulatory care sensitive conditions: terminology and disease coding need to be more specific to aid policy makers and clinicians

Ambulatory or primary care sensitive conditions (ACSCs) are those conditions for which hospital admission could be prevented by interventions in primary care. At present, different definitions of ACSCs are used for research and health policy analysis. This study aimed to explore the impact of different definitions of ACSCs and associated disease codes on analysis of health service activity. Retrospective cross-sectional study using Hospital Episode Statistics (HES). All ACSCs identified by a literature search were documented. Conditions and codes were standardized using International Classification of Diseases (ICD) 10. A subset of ACSCs commonly used in England was compared with all 36 ACSCs identified by the search in a retrospective cross-sectional study using HES. In total, 36 potential ACSCs were identified, which contained numerous subcategories. The most frequently used subset of ACSCs in the NHS only contains 19 ACSCs. There were 4,659,054 emergency admissions in England in 2005/6, of which 1,900,409 were ACSCs using the full set of 36 conditions. The proportion of these admissions attributable to the NHS subset of 19 ASCS was 35%. The underlying ICD10 codes used to define ACSCs vary widely across subsets of ACSCs used in the NHS. This impacts on rates of admission, length of stay and costs attributable to ACSCs. Rates of hospital admission for ACSCs are increasingly used as a measure of the effectiveness of primary care. However, different conceptual interpretations of the term 'ACSC' and use of differing definitions and diagnostic codes impact on the proportion of admissions that are attributed as ACSCs. Some resolution of these inconsistencies is required for this measure to be more useful to decision makers.

Adrenaline syringes are vastly over prescribed

Allergy is being seen more and more commonly. A recent review of accident and emergency admissions in England reported 415 anaphylactic cases (adults and children) from 100 000 referrals in...