School of Health and Related Research, University of Sheffield, Sheffield, UK.
Department of Health Sciences, University of Leicester, Sheffield, UK.
Emerg Med J. 2019 Jan;36(1):22-26. doi: 10.1136/emermed-2018-207505. Epub 2018 Sep 3.
We explored the urgent care axis across EDs in Yorkshire and Humber (Y&H) for patients aged ≥75 years to identify where interventions could be targeted to prevent ED attendances and inpatient admissions.
Hospital Episode Statistics (HES) data for attendances across 18 EDs in Y&H from April 2011 to March 2014 were retrospectively analysed. HES A&E and Admitted Patient Care patient records data were linked to describe the entire patient pathway. The population studied was adult patients attending type 1 EDs, comparing those ≥75 years with those under 75. Data analysed included arrival mode, presentation time, time in ED, outcome (admitted/discharged), admission length of stay, International Classification of Diseases 10th Revision (ICD-10) and cause codes related to admission. Short-stay admissions and admissions with potentially avoidable conditions (identified by ICD-10 codes and cause codes) were identified. Comparative analysis was undertaken between sites.
There were 3 736 541 ED attendances, of which 625 772 (16.7%) were ≥75 years. Older patients were significantly more likely to attend via ambulance than the younger cohort (OR 7.7, 95% CI 7.6 to 7.7), and had significantly longer median stays within ED (195 vs 136 min, p<0.001) and increased likelihood of admission (OR 4.5, 95% CI 4.5 to 4.6). Short-stay admissions accounted for 28.3% of older adult admissions. 37.3% of older adult admissions were with conditions that were potentially avoidable, accounting for 42.3% of short-stay admissions. There was regional variation in the proportions of older adults admitted (between 34.3% and 40.9%).
Large numbers of older adults present to EDs mainly by ambulance. Significant proportions are admitted for short periods with conditions that might potentially be managed outside of hospital. Variation across the region warrants further study.
我们探索了约克郡和亨伯（Y&H）的急症护理轴，以确定 75 岁及以上患者可以在何处进行干预，以防止急诊就诊和住院。
回顾性分析了 2011 年 4 月至 2014 年 3 月期间 Y&H 18 家急症室的医院入院统计数据（HES）。将 HES A&E 和入院患者护理患者记录数据进行链接，以描述整个患者路径。研究人群为成年患者，比较了 75 岁及以上患者和 75 岁以下患者。分析的数据包括到达模式、就诊时间、在 ED 中的时间、结果（住院/出院）、住院时间、国际疾病分类第 10 次修订版（ICD-10）和与入院相关的病因代码。确定了短期入院和潜在可避免的疾病入院（通过 ICD-10 代码和病因代码识别）。对站点之间进行了比较分析。
共有 3736541 例 ED 就诊，其中 625772 例（16.7%）年龄≥75 岁。与年轻队列相比，老年患者更有可能通过救护车就诊（OR 7.7，95%CI 7.6 至 7.7），并且在 ED 内的中位停留时间明显更长（195 分钟比 136 分钟，p<0.001），并且入院的可能性增加（OR 4.5，95%CI 4.5 至 4.6）。短期入院占老年成人入院的 28.3%。老年成人入院中有 37.3%的情况可能是可以避免的，占短期入院的 42.3%。老年人入院比例存在区域差异（34.3%至 40.9%）。
大量老年人主要通过救护车到 ED 就诊。相当一部分人因短期住院，其病情可能在医院外得到更好的治疗。整个地区的差异需要进一步研究。
