Number Of Daily Admissions Research Articles

Trial to End Ambulance Diversion in Boston: Report from the Conference of the Boston Teaching Hospitals Consortium

Annual ambulance diversion hours in Boston increased more than six-fold from 1997 to 2006. Although interventions and best practices were implemented, there was no reduction in the number of diversion hours. A consortium of Boston teaching hospitals instituted a two-week moratorium on citywide diversion from 02 October 2006 to 15 October 2006. The hypothesis was that there would be no significant difference in measures of hospital and emergency medical services (EMS) efficiency compared with the two weeks immediately prior. A total of nine hospitals and the municipal emergency medical services in Boston submitted data for analysis. The following mean daily hospital measures were studied: (1) emergency department volume; (2) number of emergency department admissions; (3) length of stay (LOS) for all patients; and (4) number of elopements. Mean EMS at-hospital time by destination and the percent of all Boston EMS transports to each hospital destination were calculated. The median differences (MD) were calculated as "before" minus "during" the study period and were compared with paired, Wilcoxon, non-parametric tests. Additional mean EMS measures for all destinations included: (1) to hospital time; (2) number of responses with transport initiated per day; (3) incident entry to arrival; and (4) at-hospital time. The LOS for admitted patients (MD = 0.30 hours; IQR 0.10,1.30; p = 0.03) and number of daily admissions (MD = -1.50 patients; IQR -1.50, -0.10; p = 0.04) were significantly different statistically. The results for LOS for all patients, LOS for discharged patients, ED volume, EMS time at hospital by destination, number of elopements, and percent of Boston EMS transports to each hospital revealed no statistically significant differences. The difference between the study and control periods for mean EMS to hospital time, at-hospital time, and incident entry to arrival was a maximum of 0.6 minutes. The vast majority of EMS respondents to an online survey believed that the "no diversion" policy should be made routine practice. The LOS for admitted patients decreased by 18 minutes, and the number of admissions increased by 1.5 patients per day during the study period. The "no diversion" policy resulted in minimal changes in EMS efficiency and operations. Diversion was temporarily eliminated in a major city without significant detrimental changes in ED, hospital, or EMS efficiency.

Relationship between 24-h air pollution, emergency department admission and diagnosis of acute coronary syndrome

Current available evidence suggests that air pollution, especially particulate matter <10 mum in aerodynamic diameter (PM10), has acute and chronic effects on health. We aimed to evaluate the epidemiological association between 24-h PM10 levels and acute coronary syndrome (ACS). We analyzed the number of daily admissions at the emergency unit (ED) of patients with suspected ACS, and the number of daily diagnosis of ACS in the same local ED according to the 24-h PM10, over a nearly 3-month period. 209 out of the 1,688 patients admitted to the ED with a clinical suspicion of ACS had a definitive diagnosis of ACS. Whereas the mean number of ED admissions for suspected ACS did not differ significantly according to the 24-h levels of PM10 (18 +/- 1 vs. 17 +/- 1; P = 0.13), the mean number of diagnoses of ACS was 26% higher when the 24-h levels of PM10 were >50 microg/m(3) (2.4 +/- 0.2 vs. 1.9 +/- 0.2; P = 0.03). A statistically significant association was also observed between 24-h PM10 levels and daily number of ACS diagnoses (r = 0.26; P < 0.001), but not between 24-h PM10 levels and daily ED accesses for suspected ACS (r = 0.12; P = 0.24). Taken together, these results support the existence of an epidemiologic association between air pollution and acute cardiovascular events.

Statistical analysis of temperature impact on daily hospital admissions: analysis of data from Udine, Italy

This article is devoted to the analysis of the relationship between the health status of an urban population and meteorological variables. The analysis considers daily number of hospital admissions, not due to surgery, regarding the population resident in the Municipality of Udine, aged 75 and over. Hourly records on temperature, humidity, rain, atmospheric pressure, solar radiation, wind velocity and direction recorded at an observation site located near the center of Udine are considered. The study also considers hourly measures of pollutant concentrations collected by six monitoring stations. All data are relative to the summer periods of years 1995–2003. Generalized additive models (GAM) are used in which the response variable is the number of hospital admissions and is assumed to be distributed as a Poisson whose rate varies as a possibly non-linear function of the meteorological variables and variables allowing for calendar effects and pollutant concentrations. The subsequent part of the analysis explores the distribution of temperature conditional on the number of daily admissions through quantile regression. A non-linear (N-shaped) relationship between hospital admissions and temperature is estimated; temperature at 07:00 is selected as a covariate, revealing that nighttime temperature is more relevant than daytime. The quantile regression analysis points out, as expected, that the distribution of temperature on days with more admissions has higher q-quantiles with q near unity, while a clear-cut conclusion is not reached for q quantiles with q near 0. Copyright © 2005 John Wiley & Sons, Ltd.

Asthma and ambient air pollution in Helsinki.

To study whether ambient air levels of sulphur dioxide (SO2), nitrogen dioxide (NO2), total suspended particulates (TSP), and ozone (O3) affect the number of hospital admissions for asthma. The associations between the daily number of admissions and air pollutants were analysed with Poisson regression, taking into account potential confounding factors by using the standardised protocol of the APHEA project. Helsinki, Finland, 1987-89. Patients admitted to hospitals through emergency rooms because of asthma (n = 2421). The daily mean concentration was 13-25 micrograms/m3 for SO2, 33-41 micrograms/m3 for NO2, 19-41 micrograms/m3 for O3, and 58-109 micrograms/m3 for TSP during the different seasons. Values are means for various stations. The daily mean temperature during the three year period was +5.4 degrees C (range -37-27 degrees C). Positive associations with admissions were observed for O3 levels in all children under 14 years, and for SO2 levels in 15-64 year olds and among those older than 64. Significant associations were also seen between admissions for digestive tract diseases (the control) and O3 levels. This suggests that the modelling, which proved to be problematic, was unsatisfactory, or it may be a statistical coincidence. A rise in temperature was associated with a low number of admissions for asthma among 0-14 year olds and among 15-64 year olds, whereas humidity did not have a significant effect on the number of admissions. It is possible than even low level pollution may increase hospital admissions for asthma. However, definitive conclusions will be justified only after meta-analysis comprising several studies. The methodology was seen to have a strong effect on the results and standardised methods, possibly differing from those for the study concerning mortality, are needed to investigate the association between morbidity and ambient air pollutants.

Chronic Bronchitis, Emphysema, and Low-Level Air Pollution in Helsinki, 1987-1989

The effects of low levels of air pollution and weather conditions on the number of patients admitted to hospitals for exacerbation of chronic bronchitis or emphysema (n = 2807) was studied in Helsinki during a 3-year period, 1987-1989. The daily number of admissions via the emergency room was significantly associated with prevailing levels of sulfur dioxide (SO2) and nitrogen dioxide (NO2) in Poisson regressions controlled for weather, season, time trends, and day of the week, whereas the total number of admissions (via the emergency room and otherwise) was not significantly associated with these pollutants. The effect of SO, was observed only among those under 65 years old; a significant peak of admissions was seen during the same day (RR, 1.31 for a 2.7-fold increase in SO2; 95% CI, 1.01-1.70; P = 0.039), and another after a 3-day lag (RR, 1.39; 95% CI, 1.05-1.86; P = 0.021). The effect of NO2 was strongest after a 6-day lag and was significant only among those over 64 years old (RR, 1.31;95% CI, 1.03-1.66; P = 0.022). The average of mean 24-hr concentrations of NO, was 39 μg/m3 (0.021 ppm) and that for SO2 was 19 mu g/m3 (0.0067 ppm). No relationship was found between admissions and the concentrations of total suspended particulates (TSP) or ozone (O3), the temperature, or the relative humidity. However, the number of admissions among those over 64 years of age was significantly lower, irrespective of temperature, during the summer than during other seasons. The mean daily concentration of O3 was fairly low (22 μg/m3 or 0.011 ppm), but that of TSP was high, 76 μg/m3. The mean temperature was low, +4.7°C. These results suggest that SO2 and NO2 concentrations lower than those given as guidelines in many countries, and lower than previously shown, may increase the incidence of symptoms in some patients with chronic bronchitis or emphysema.

THE INFLUENZA EPIDEMIC AT CAMP DIX, N. J.

The influenza epidemic began at Camp Dix, [ill] 15, and ended, October 6. The number of daily admissions increased rapidly and reached the maximum, September 26, on which day 806 patients were received, making a total of 4,025 in the hospital on that date. The number then decreased daily, reaching the normal average of eighty admissions, October 7. During the twenty-two days of the epidemic, 6,500 patients were cared for. Approximately 6,000 of these men had influenza. There have been 800 deaths due to the epidemic. Four of our nurses and one dietitian died during the epidemic, contracting the disease while on duty. One medical officer was taken ill while on leave and died from bronchopneumonia a few days later at the Massachusetts General Hospital. When the epidemic began to subside and the hospital discharges to increase, wards were consolidated as rapidly as possible. The emptied wards were renovated and disinfected