Increase In Emergency Admissions Research Articles

Effect of COVID-19 Pandemic on Admission Pattern to Pediatric Surgery Division at King Fahad University Hospital and Subsequent Quality of Presentation in Cases: A Comparative Study and Single-Center Experience.

The coronavirus disease 2019 (COVID-19) pandemic has affected healthcare systems worldwide, with mandatory quarantine and isolation measures being implemented to curb the spread of the virus. These measures have potentially led to delayed or complicated presentations of non-COVID-19 cases, including pediatric surgical cases. This study aims to evaluate pediatric surgical admission patterns, analyze the incidence of surgical diagnoses, and assess the severity of presentation during the COVID-19 period compared to the pre-COVID-19 period. This retrospective observational study was conducted at a university hospital in the eastern region of Saudi Arabia to assess the effect of the pandemic on pediatric surgery admissions patterns and severity of presentation duringthe COVID-19 period (March 2, 2020, to March 1, 2022) and pre-COVID-19 period (March 1, 2018, to March 1, 2020). Of the 903 pediatric surgical admissions, 366 (40.5%) presented during the COVID-19 period. The admission rate per month decreased by 6.9 during COVID-19 compared to pre-COVID-19 (mean [SD]: 21.5 [9.3] vs. 14.6 [8.2], p = 0.01). The most common admission diagnoses were appendicitis (17.5%) and inguinal hernia (15.8%). There was a 15% increase in the percentage of emergency admissions (54.4% vs. 47.3%, p = 0.037) during COVID-19 compared to pre-COVID-19. Of note, the percentage of patients admitted with acute appendicitis increased by 35.9% (20.8% vs. 15.3%, p = 0.03). Furthermore, the emergency admissions for patients with inguinal hernia doubled (26.6% vs. 12.7%, p = 0.035). No significant difference in ICU admissions, hospital length of stay, and routine discharge were observed. In conclusion, the COVID-19 pandemic correlated with a significant decrease in overall admissions and an increase in emergency admissions, including those for appendicitis and inguinal hernia. The increase in complicated conditions was not significant. There was no significant difference in ICU admissions and hospital length of stay. Future studies involving multiple centers are necessary to validate these findings.

The impact of an integrated care intervention on mortality and unplanned hospital admissions in a disadvantaged community in England: A difference-in-differences study

BackgroundMany health systems are experimenting with integrated care models to improve outcomes and reduce healthcare demand. Evidence for effects on health service utilisation is variable, with few studies investigating impacts on mortality or differences by socioeconomic group. ObjectiveTo examine the impact of a multidisciplinary, integrated care team intervention on emergency admissions and mortality, and whether effects differed by deprivation group. DesignA longitudinal matched controlled study using difference-in-differences analysis comparing the change in unplanned emergency admissions twelve months before and after the intervention, and inverse probability of treatment-weighted survival analysis comparing mortality, between intervention and matched control groups. SettingA relatively deprived city in England, U.K. InterventionA case-management integrated care programme delivered through multidisciplinary teams and aimed at complex needs and/or high hospitalisation risk patients. ResultsThe intervention was associated with a small increase in emergency admissions of 15 per 1,000 patients per month (95% CI 5 to 24, p = 0.003) after the intervention relative to the control group and no significant change in survival between intervention and control groups (HR 0.9, 95% CI 0.84 to 1.13, p = 0.7). Effects were similar across age and deprivation groups. ConclusionsIt is unlikely that similar interventions lead to reduced emergency admissions or increased survival. Further studies should use experimental methods and assess impacts on quality of life.

Evolution of Emergency Department Characteristics in Child and Adolescent Psychiatry: A Retrospective Review over Two Decades

Evolution of Emergency Department Characteristics in Child and Adolescent Psychiatry: A Retrospective Review over Two Decades Abstract. Objective: Emergency inpatient admissions to child and adolescent psychiatric hospitals because of a mental health crisis represent a substantial proportion of all inpatient admissions and have increased substantially over time. This study examines changes in the characteristics of this patient group at a university care clinic over two decades. Method: We evaluated the emergency admissions from 1996, 2002, 2008, and 2014 of the Child and Adolescent Psychiatry Clinic in Tübingen retrospectively using sociodemographic data, psychosocial circumstances, and diagnoses. Results: We evaluated a total of N = 403 emergency admissions. The emergency admissions in the periods mentioned increased by 405 %. Especially patients from families with separated parents and with multiple diagnoses increased over time. Conclusions: From 1996 to 2014, there was a significant increase in emergency admissions. The results also indicate that more complex disease situations and less favorable psychosocial conditions are occurring. The findings underscore the need to improve the clinical care of children and adolescents during acute mental health crises and work toward their prevention. There is also a need to focus broad societal discussion on improving overall mental health during childhood development. There is an urgent need for prospective studies to identify the factors leading to the increase in emergency admissions among children and adolescents.

658 Managing the Acute Surgical Patient – How has COVID-19 Changed Our Approach?

AimCOVID-19 has changed how surgical admissions are triaged and treated. This retrospective cohort study aims to detail the effects of a national lockdown on emergency general surgical referrals at a tertiary centre.MethodA retrospective search identified all emergency general surgery referrals prior to and during the UK national lockdown. Pre (10-23 Feb 2020;PLG) and intra-lockdown (30 Mar-12 Apr 2020;ILG) groups were compared using descriptive statistics and significance was quantified with Chi-squared.Results600 patients were included of which 426 (71%) presented in the PLG. The PLG had proportionally fewer ED referrals (40.8%vs.51.1%, p = 0.02) and less cross-sectional imaging performed (31.5%vs.40.8%, p = 0.03). There was a significant reduction in non-specific abdominal pain (NSAP) during lockdown (25.12%vs.14.94%, p = 0.007). GP referrals (48.8%vs.46.6%, p = 0.61), admission (46.2%vs.44.8%, p = 0.09) and operative intervention (21.4% vs.17.24%, p = 0.25) showed no disparity.ConclusionsPredictably, the advent of lockdown resulted in a reduction in hospital attendance and surgical referrals. Our data showed a similar proportion of referred patients admitted pre- and intra-lockdown despite a reduction in absolute terms. This may be due to a trend towards later presentation coupled with a focus on conservative management and prevention of admission. The decrease in NSAP raises questions that require further exploration. Cross-sectional imaging was used more freely as an adjunct in the ILG suggesting increasing acuity and delayed presentation or may result from a tendency towards image-guided discharge. Admissions have since trended towards pre-lockdown levels, but it is yet to be seen if a reduction in elective operating will lead to an increase in emergency admissions.

Forecasting the Requirement for Nonelective Hospital Beds in the National Health Service of the United Kingdom: Model Development Study.

BackgroundOver the last decade, increasing numbers of emergency department attendances and an even greater increase in emergency admissions have placed severe strain on the bed capacity of the National Health Service (NHS) of the United Kingdom. The result has been overcrowded emergency departments with patients experiencing long wait times for admission to an appropriate hospital bed. Nevertheless, scheduling issues can still result in significant underutilization of bed capacity. Bed occupancy rates may not correlate well with bed availability. More accurate and reliable long-term prediction of bed requirements will help anticipate the future needs of a hospital’s catchment population, thus resulting in greater efficiencies and better patient care.ObjectiveThis study aimed to evaluate widely used automated time-series forecasting techniques to predict short-term daily nonelective bed occupancy at all trusts in the NHS. These techniques were used to develop a simple yet accurate national health system–level forecasting framework that can be utilized at a low cost and by health care administrators who do not have statistical modeling expertise.MethodsBed occupancy models that accounted for patterns in occupancy were created for each trust in the NHS. Daily nonelective midnight trust occupancy data from April 2011 to March 2017 for 121 NHS trusts were utilized to generate these models. Forecasts were generated using the three most widely used automated forecasting techniques: exponential smoothing; Seasonal Autoregressive Integrated Moving Average; and Trigonometric, Box-Cox transform, autoregressive moving average errors, and Trend and Seasonal components. The NHS Modernisation Agency’s recommended forecasting method prior to 2020 was also replicated.ResultsThe accuracy of the models varied on the basis of the season during which occupancy was forecasted. For the summer season, percent root-mean-square error values for each model remained relatively stable across the 6 forecasted weeks. However, only the trend and seasonal components model (median error=2.45% for 6 weeks) outperformed the NHS Modernisation Agency’s recommended method (median error=2.63% for 6 weeks). In contrast, during the winter season, the percent root-mean-square error values increased as we forecasted further into the future. Exponential smoothing generated the most accurate forecasts (median error=4.91% over 4 weeks), but all models outperformed the NHS Modernisation Agency’s recommended method prior to 2020 (median error=8.5% over 4 weeks).ConclusionsIt is possible to create automated models, similar to those recently published by the NHS, which can be used at a hospital level for a large national health care system to predict nonelective bed admissions and thus schedule elective procedures.

Comparison of the impact of two national health and social care integration programmes on emergency hospital admissions

BackgroundPolicy-makers expect that integration of health and social care will improve user and carer experience and reduce avoidable hospital use. We evaluate the impact on emergency hospital admissions of two large nationally-initiated service integration programmes in England: the Pioneer (November 2013 to March 2018) and Vanguard (January 2015 to March 2018) programmes. The latter had far greater financial and expert support from central agencies.MethodsOf the 206 Clinical Commissioning Groups (CCGs) in England, 51(25%) were involved in the Pioneer programme only, 22(11%) were involved in the Vanguard programme only and 13(6%) were involved in both programmes. We used quasi-experimental methods to compare monthly counts of emergency admissions between four groups of CCGs, before and after the introduction of the two programmes.ResultsCCGs involved in the programmes had higher monthly hospital emergency admission rates than non-participants prior to their introduction [7.9 (95% CI:7.8–8.1) versus 7.5 (CI:7.4–7.6) per 1000 population]. From 2013 to 2018, there was a 12% (95% CI:9.5–13.6%) increase in emergency admissions in CCGs not involved in either programme while emergency admissions in CCGs in the Pioneer and Vanguard programmes increased by 6.4% (95% CI: 3.8–9.0%) and 8.8% (95% CI:4.5–13.1%), respectively. CCGs involved in both initiatives experienced a smaller increase of 3.5% (95% CI:-0.3–7.2%). The slowdown largely occurred in the final year of both programmes.ConclusionsHealth and social care integration programmes can mitigate but not prevent rises in emergency admissions over the longer-term. Greater financial and expert support from national agencies and involvement in multiple integration initiatives can have cumulative effects.

New integrated care models in England associated with small reduction in hospital admissions in longer-term: A difference-in-differences analysis

Closer integration of health and social care services has become a cornerstone policy in many developed countries, but there is still debate over what population and service level is best to target. In England, the 2019 Long Term Plan for the National Health Service included a commitment to spread the integration prototypes piloted under the Vanguard `New Care Models’ programme. The programme, running from 2015 to 2018, was one of the largest pilots in English history, covering around 9 % of the population. It was largely intended to design prototypes aimed at reducing hospital utilisation by moving specialist care out of hospital into the community and by fostering coordination of health, care and rehabilitation services for (i) the whole population (‘population-based sites’), or (ii) care home residents (‘care home sites’).We evaluate and compare the efficacy of the population-based and care home site integrated care models in reducing hospital utilisation. We use area-level monthly counts of emergency admissions and bed-days obtained from administrative data using a quasi-experimental difference-in-differences design.We found that Vanguard sites had higher hospital utilisation than non-participants in the pre-intervention period. In the post-intervention period, there is clear evidence of a substantial increase in emergency admissions among non-Vanguard sites. The Vanguard integrated care programme slowed the rise in emergency admissions, especially in care home sites and in the third and final year. There was no significant reduction in bed-days.In conclusion, integrated care policies should not be relied upon to make large reductions in hospital activity in the short-run, especially for population-based models.

Are frail elderly people in Europe high-need subjects? First evidence from the SPRINTT data

Physical frailty and sarcopenia (PF&S) has received growing attention in empirical models of health care use. However, few articles focused on objective measures of PF&S to assess the extent of care consumption among the frail population at risk of dependency. Using baseline data from the SPRINTT study, a sample of 1518 elderly people aged 70+ recruited in eleven European countries, we analyse the association between various PF&S measures and health care / long term care (LTC) use. Multiple health care and LTC outcomes are modelled using linear probability models adjusted for a range of individual characteristics and country fixed effects. We find that PF&S is associated with a significant increase in emergency admissions and hospitalizations, especially among low-income elders. All PF&S measures are significantly associated with increased use of formal and informal LTC. There is a moderating effect of income on LTC use: poor frail elders are more likely to use any of the formal LTC services than rich frail elders. Our results are robust to various statistical specifications. They suggest that the inclusion of PF&S in the eligibility criteria of public LTC allowances could contribute to decrease the economic gradient in care use among the elderly community-dwelling European population.

Exploring the association between short-term exposure to ambient fine particulate matter pollution and emergency admissions for peptic ulcer bleeding in Beijing, China

BackgroundAir pollution affects the pathophysiology of gastrointestinal tract and has been linked to several gastrointestinal diseases in recent years. However, little is known about the association of air pollution with peptic ulcer bleeding (PUB). We aimed to conduct a time-series study to examine the association between short-term exposure to fine particulate matter (PM2.5) and emergency admissions for PUB in Beijing, China. MethodsData on emergency admissions for PUB between January 1, 2010, and June 30, 2012 were obtained from the Beijing Medical Claim Data for Employees. Measurements of PM2.5 concentration were obtained from the United States Embassy air-monitoring station. A generalized additive Poisson model was applied to explore the association between PM2.5 concentrations and emergency admissions for PUB, with stratification by gender and age. ResultsA total of 5123 emergency admissions for PUB were identified. Short-term exposure to outdoor PM2.5 was significantly associated with increased emergency admissions for PUB at lag0 day. A 10 μg/m3 increase in PM2.5 concentration at lag0 day corresponded to a 0.56% (95% confidence interval (CI) 0.04%–1.08%; P = 0.035) increase in emergency admissions for PUB. There was a clear concentration-response association between PM2.5 concentrations and emergency admissions for PUB. The PM2.5 effect estimates were greater in elderly people (≥65 years old) with the difference approaching statistical significance (percentage change 0.78, 95% CI 0.03%–1.54% in patients ≥65 years old; percentage change 0.32, 95% CI -0.38%–1.03% in patients <65 years old; P = 0.073), but the difference between men and women was not significant (percentage change 0.75, 95% CI 0.08%–1.43% in man; percentage change 0.27, 95% CI -0.51%–1.07% in woman; P = 0.368). ConclusionShort-term elevation in outdoor PM2.5 concentrations was associated with increased emergency admissions for PUB, particularly in elderly people. Future studies are warranted to confirm the findings and elucidate the mechanisms underlying the association.

Identifying and characterizing the effects of calendar and environmental conditions on pediatric admissions in Shanghai

BackgroundGlobal environmental pollution caused by human activities has become a threat to public health. Children are especially susceptible to adverse environmental conditions owing to their unique physiological and behavioral characteristics. A number of studies have demonstrated associations between the incidence of some childhood diseases and adverse environmental conditions. Shanghai is the largest and most important economic center in China. After rapid population expansion in recent decades, the shortage of pediatric medical resources is becoming a serious public health problem. This study aimed to identify and characterize the social and environmental effect of adverse environmental conditions on overall pediatric admissions at hospitals in Shanghai, China.MethodsThis was a multi-center study spanning from January, 2013 to November, 2014. Daily pediatric admission data (~ 12,000 overall pediatric admissions/day) of three tertiary pediatric hospitals were collected from the large-scale health information exchange network of Shanghai. We linked the admission data with local environmental data. A seasonal decomposition method was applied to a time-trend analysis of the admission data; a generalized additive model was applied to model the association between environmental measurements and admissions data.ResultsAdmissions to outpatient and emergency departments were highly influenced by calendar factors; however, these same factors showed opposite effects on different clinical departments. The effect of nitrogen dioxide was a 0.27% increase (95% confidence interval (CI) 0.23% to 0.32%) in outpatient admissions and 0.78% (95% CI 0.68% to 0.88%) increase in emergency admissions. Concentrations of fine particles ≤ 2.5 micrometers in diameter (PM2.5) and carbon monoxide (CO) showed multi-faceted effects on pediatric admissions. PM2.5 and CO concentrations were significantly associated with decreased current-day outpatient admissions but also significantly associated with increased current-day emergency admissions at all three hospitals.ConclusionsBased on the health information exchange network of Shanghai, we conducted a large-scale, multi-center retrospective study of the association between adverse environmental conditions and pediatric admissions. Our study contributes to environmental health research in children and may guide decision-making regarding pediatric resource planning and policies.

Short-term PM2.5 exposure and emergency hospital admissions for mental disease

Epidemiologic studies regarding the relationship between short-term exposure to particulate matter with a median aerodynamic diameter < 2.5 µm (PM2.5) and mental disease are limited. This study examined the effects of short-term exposure to PM2.5 on emergency admissions to the hospital for mental disease in Seoul, Korea.Data regarding 80,634 emergency admissions for mental diseases were collected from a nationally centralized healthcare claims database in Seoul during 2003–2013. Generalized linear models with climate variables were used to examine associations between short-term PM2.5 exposure and mental disease admissions. To comprehensively assess PM2.5 effects, we used single- and two-pollutant models, which considered other pollutants in combination with PM2.5.The relative risk (RR) of emergency admissions for mental disease was 1.008 (95% confidence interval, 1.001–1.015) for each 10 μg/m3 increase in 2-day average PM2.5 concentration. This effect persisted or became slightly stronger in the two-pollutant models that included carbon monoxide, nitrogen dioxide, ozone, or sulfur dioxide (RR, 1.01–1.021), but association appeared to be limited to individuals < 65 years of age. Significant association was estimated only during the warm season (RR, 1.021–1.023) in the two-pollutant models. The exposure–response curve was steeper at lower concentrations, suggesting that the risk of mental disease at lower concentrations of pm2.5 (0–30 µg/m3). PM2.5 was associated with increased admissions even when it was below the World Health Organization's Air Quality Guidelines (25 μg/m3), but the association was not statistically significant.Thus, based on the data from a large database, exposure to PM2.5 was associated with increases in emergency admissions for mental diseases, and this association was significant during the warm season. PM2.5 may even affect mental disease at levels below the current air quality guidelines. These results provide substantial insight regarding the effects of air pollutants and have important implications for policy makers.

Improving care for older people with long-term conditions and social care needs in Salford: the CLASSIC mixed-methods study, including RCT

BackgroundThe Salford Integrated Care Programme (SICP) was a large-scale transformation project to improve care for older people with long-term conditions and social care needs. We report an evaluation of the ability of the SICP to deliver an enhanced experience of care, improved quality of life, reduced costs of care and improved cost-effectiveness.ObjectivesTo explore the process of implementation of the SICP and the impact on patient outcomes and costs.DesignQualitative methods (interviews and observations) to explore implementation, a cohort multiple randomised controlled trial to assess patient outcomes through quasi-experiments and a formal trial, and an analysis of routine data sets and appropriate comparators using non-randomised methodologies.SettingSalford in the north-west of England.ParticipantsOlder people aged ≥ 65 years, carers, and health and social care professionals.InterventionsA large-scale integrated care project with three core mechanisms of integration (community assets, multidisciplinary groups and an ‘integrated contact centre’).Main outcome measuresPatient self-management, care experience and quality of life, and health-care utilisation and costs.Data sourcesProfessional and patient interviews, patient self-report measures, and routine quantitative data on service utilisation.ResultsThe SICP and subsequent developments have been sustained by strong partnerships between organisations. The SICP achieved ‘functional integration’ through the pooling of health and social care budgets, the development of the Alliance Agreement between four organisations and the development of the shared care record. ‘Service-level’ integration was slow and engagement with general practice was a challenge. We saw only minor changes in patient experience measures over the period of the evaluation (both improvements and reductions), with some increase in the use of community assets and care plans. Compared with other sites, the difference in the rates of admissions showed an increase in emergency admissions. Patient experience of health coaching was largely positive, although the effects of health coaching on activation and depression were not statistically significant. Economic analyses suggested that coaching was likely to be cost-effective, generating improvements in quality of life [mean incremental quality-adjusted life-year gain of 0.019, 95% confidence interval (CI) –0.006 to 0.043] at increased cost (mean incremental total cost increase of £150.58, 95% CI –£470.611 to £711.776).LimitationsThe Comprehensive Longitudinal Assessment of Salford Integrated Care study represents a single site evaluation, with consequent limits on external validity. Patient response rates to the cohort survey were &lt; 40%.ConclusionsThe SICP has been implemented in a way that is consistent with the original vision. However, there has been more rapid success in establishing new integrated structures (such as a formal integrated care organisation), rather than in delivering mechanisms of integration at sufficient scale to have a large impact on patient outcomes.Future workFurther research could focus on each of the mechanisms of integration. The multidisciplinary groups may require improved targeting of patients or disease subgroups to demonstrate effectiveness. Development of a proven model of health coaching that can be implemented at scale is required, especially one that would provide cost savings for commissioners or providers. Similarly, further exploration is required to assess the longer-term benefits of community assets and whether or not health impacts translate to reductions in care use.Trial registrationCurrent Controlled Trials ISRCTN12286422.FundingThis project was funded by the NIHR Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 31. See the NIHR Journals Library website for further project information.

The role of the Quality and Outcomes Framework in the care of long-term conditions: a systematic review.

BackgroundImproving care for people with long-term conditions is central to NHS policy. It has been suggested that the Quality and Outcomes Framework (QOF), a primary care pay-for-performance scheme that rewards practices for delivering effective interventions in long-term conditions, does not encourage high-quality care for this group of patients.AimTo examine the evidence that the QOF has improved quality of care for patients with long-term conditions.Design and settingThis was a systematic review of research on the effectiveness of the QOF in the UK.MethodThe authors searched electronic databases for peer-reviewed empirical quantitative research studying the effect of the QOF on a broad range of processes and outcomes of care, including coordination and integration of care, holistic and personalised care, self-care, patient experience, physiological and biochemical outcomes, health service utilisation, and mortality. Because the studies were heterogeneous, a narrative synthesis was carried out.ResultsThe authors identified three systematic reviews and five primary research studies that met the inclusion criteria. The QOF was associated with a modest slowing of both the increase in emergency admissions and the increase in consultations in severe mental illness (SMI), and modest improvements in diabetes care. The nature of the evidence means that the authors cannot be sure that any of these associations is causal. No clear effect on mortality was found. The authors found no evidence that the QOF influences integration or coordination of care, holistic care, self-care, or patient experience.ConclusionThe NHS should consider more broadly what constitutes high-quality primary care for people with long-term conditions, and consider other ways of motivating primary care to deliver it.

The ageing society and emergency hospital admissions

There is strong policy interest, in England as elsewhere, in slowing the growth in emergency hospital admissions, which for older people increased by 3.3% annually between 2001/2 and 2012/3. Resource constrains have increased the importance of understanding rising emergency admissions, which in policy discourse is often explained by population aging. This study examines how far the rise in emergency admissions of people over 65 was due to population ageing, how far to the changing likelihood of entering hospital at each age, and how far to other factors which might be more amenable to policy measures. It shows that: admission rates rose with age from age 40 upward but each successive birth cohort experienced lower emergency admission rates after standardising for age and other effects. This downward cohort effect largely offset the consequences of an older and larger population aged over 65. Other factors which could explain increasing admissions, such as new technologies or rising expectations, appear more important than the changing size and age structure of the population as drivers of rising emergency admissions in old age. These findings suggest that stemming the rate of increase in emergency admissions of older people may be feasible, if challenging, despite population ageing.

Association between emergency admission for peptic ulcer bleeding and air pollution: a case-crossover analysis in Hong Kong's elderly population

Air pollution increases intestinal permeability, alters the gut microbiome, and promotes inflammation, which might contribute towards gastrointestinal bleeding. In the present study, we aim to examine whether short-term elevations in air pollution are associated with increased numbers of emergency hospital admissions for peptic ulcer bleeding in Hong Kong. Daily air pollution (particulate matter with aerodynamic diameter less than 2·5 μm [PM2·5], nitric oxide [NO2], sulpher dioxide [SO2], and ozone [O3]) data during 2005-10 were collected from the Environmental Protection Department and emergency admission data for peptic ulcer bleeding in elderly people (aged 65 years or older) from the Hospital Authority of Hong Kong. A time stratified case-crossover analysis with conditional logistic regression was used to estimate the excess risk of peptic ulcer bleeding associated with each air pollutant, in single-pollutant and multi-pollutant models. Cardiorespiratory diseases were used as positive controls. 8566 emergency admissions for peptic ulcer bleeding were recorded among Hong Kong's elderly population during 2005-10; the daily number of admissions ranged from 0 to 13. An IQR increment of 5-day moving average (lag04) of NO2 concentration (25·8 μg/m3) was associated with a 7·6% (95% CI 2·2-13·2) increase in emergency admissions for peptic ulcer bleeding. Multi-pollutant models confirmed the robustness of the risk estimates for NO2. Other pollutants (PM2·5, SO2, and O3) were not associated with peptic ulcer bleeding admissions. Short-term elevation in ambient NO2 might trigger peptic ulcer bleeding events and increase the risk of emergency admissions for peptic ulcer bleeding in Hong Kong's elderly population. These findings strengthen the hypothesis that air pollution affects not just cardiopulmonary diseases, but also certain diseases of the digestive system. None.

PATIENTS ADMITTED FROM THE EMERGENCY DEPARTMENT INTO AN ACUTE MEDICINE BED FOR LESS THAN TWENTY FOUR HOURS–ARE THESE ADMISSIONS JUSTIFIED?

Objectives & BackgroundThe increase in emergency admissions over the past 15 years has come almost entirely from the EDs,for patients who spend two days or less in hospital. It has...

Longitudinal Trend Analysis Shows an Increase in Emergency Admissions for Laparoscopic Cholecystectomy

Longitudinal Trend Analysis Shows an Increase in Emergency Admissions for Laparoscopic Cholecystectomy

Small Area Spread of a New Type of Infectious Condition across Berkshire in England between June 2011 and March 2013: Effect on Medical Emergency Admissions

Aims: This study aims to investigate the small area spread of a presumed infectious agent, and to determine which factors determined the point of initiation, speed of the spread and the resulting increase in emergency medical admissions. Study Design: Analysis of a monthly time series of medical admissions using small area population aggregates of around 7,000 population contained within the census spatial unit called a Mid Super Output Area (MSOA). Place and Duration of Study: Emergency medical group admissions for residents of the six unitary authority locations in Berkshire, southern England between January 2008 and March 2013. Methodology: A running twelve month total of admissions was used to determine the point of Original Research Article Jones and Beauchant; BJMMR, 6(1): 126-148, 2015; Article no.BJMMR.2015.190 127 initiation and the extent of a step-like increase in medical admissions. Results: Analysis shows evidence for spatial spread initiating around June 2011 through to March 2013. At onset, medical admissions increase and stay high for 12 to 18 months before beginning to abate. This spread commenced earlier among mainly Asian small areas (clustered from July 2011 onward) and later (clustered around March 2012) in predominantly affluent white areas. The observed percentage increase in admissions within the unitary authority areas varied from 25% to 51% (median value), however the average increase was highest as the geographic area became smaller, and this is suggested to arise from the aggregation of smaller social networks where the point of initiation of infectious spread occurs over time. The percentage increase in admissions displayed high single-year-of-age specificity suggestive of the immune phenomena called antigenic original sin, and is therefore suggestive of a different strain of an agent with previous outbreaks. The increase in emergency admissions showed a month-of-year pattern which appeared to follow the seasonal pattern of vitamin D levels in the blood. The presence of nursing homes, deprivation and ethnicity also has an effect on the average increase in admissions. Conclusion: It is suggested that all the above point to an outbreak of a previously uncharacterized type of infectious agent. There are profound implications regarding the use of standard five year age bands for the standardization of medical admission rates.

Effects of dust storm events on emergency admissions for cardiovascular and respiratory diseases in Sanandaj, Iran.

BackgroundIn recent years, increasing dust storms from western neighboring countries of Iran influenced western and central parts of the country. In this case, level of concentration of atmospheric particulate matter greater than 10 μm (PM10) remained higher for several days compared to the levels before the event. Accordingly, Suspended particulate matters of dust storms in western Iran have caused PM10 pollution in Sanandaj (capital of the Iranian province of Kurdistan) and other Iranian cities. The present study aimed to evaluate possible effects of dust storms on incidence of cardiovascular and respiratory diseases among residents of Sanandaj.Materials and methodsDust storm events defined based on the Environmental Protection Administration and Meteorological Announcements, 21 March 2009 to 21 June 2010. Data related to the dust events associated with cardiovascular and respiratory diseases were obtained from the Center for Disaster and Emergency Medicine of Sanandaj, Iran. PM10 concentration and air quality data were obtained from air quality monitoring agency of Kurdistan Provincial Directorate of Environment Protection. Daily PM10 measurements were performed automatically according to β-ray absorption. Data were statistically analyzed using SPSS and Pearson's correlation coefficient. Also, linear regression model was used to investigate the relationship between variables.ResultsThe average PM10 levels during dust episodes (187 μg/m3) were significantly higher than the other days (48.7 μg/m3). In addition, correlation coefficient between PM10 level and number of cardiovascular and emergency service during dust events were equal to 0.48 (P <0.05) and 0.19 (P >0.05) respectively.ConclusionOur findings showed significant increase in emergency admissions for cardiovascular and respiratory diseases during dust storms episode in Sanandaj. Although correlation between respiratory diseases and dust storm events were statistically insignificant (0.19), numbers of cardiovascular diseases were significantly correlated with dust storm events (0.48).

The real cost of primary care

The crisis in accident and emergency departments leads me to share the results of an analysis from East Devon. Two years ago we worked with hospital colleagues to identify the cause of the large increase in emergency admissions in our area. East Devon has a population structure equivalent to that projected for England and Wales in 2042; we found that people aged over 80 years formed the bulk of the increase in emergency admissions and, to a lesser extent, attendances at the emergency department of our main acute hospital. We …