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Factors associated with longer wait times, admission and reattendances in older patients attending emergency departments: an analysis of linked healthcare data.
Maynou, Laia; Street, Andrew; Burton, Christopher; Mason, Suzanne M; Stone, Tony; Martin, Graham; van Oppen, James; Conroy, Simon.
  • Maynou L; Department of Econometrics, Statistics and Applied Economics, Universitat de Barcelona, Barcelona, Spain laia.maynou@ub.edu.
  • Street A; Department of Health Policy, The London School of Economics and Political Science, London, UK.
  • Burton C; Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Barcelona, Spain.
  • Mason SM; Department of Health Policy, The London School of Economics and Political Science, London, UK.
  • Stone T; Centre for Urgent and Emergency Care Research, School of Health and Related Research, The University of Sheffield, Sheffield, UK.
  • Martin G; Centre for Urgent and Emergency Care Research, School of Health and Related Research, The University of Sheffield, Sheffield, UK.
  • van Oppen J; Centre for Urgent and Emergency Care Research, School of Health and Related Research, The University of Sheffield, Sheffield, UK.
  • Conroy S; THIS Institute, University of Cambridge, Cambridge, UK.
Emerg Med J ; 40(4): 248-256, 2023 Apr.
Article en En | MEDLINE | ID: mdl-36650039
ABSTRACT
BACKGROUND AND

OBJECTIVE:

Care for older patients in the ED is an increasingly important issue with the ageing society. To better assess the quality of care in this patient group, we assessed predictors for three outcomes related to ED care being seen and discharged within 4 hours of ED arrival; being admitted from ED to hospital and reattending the ED within 30 days. We also used these outcomes to identify better-performing EDs.

METHODS:

The CUREd Research Database was used for a retrospective observational study of all 1 039 251 attendances by 368 754 patients aged 75+ years in 18 type 1 EDs in the Yorkshire and the Humber region of England between April 2012 and March 2017. We estimated multilevel logit models, accounting for patients' characteristics and contact with emergency services prior to ED arrival, time variables and the ED itself.

RESULTS:

Patients in the oldest category (95+ years vs 75-80 years) were more likely to have a long ED wait (OR=1.13 (95% CI=1.10 to 1.15)), hospital admission (OR=1.26 (95% CI=1.23 to 1.29)) and ED reattendance (OR=1.09 (95% CI=1.06 to 1.12)). Those who had previously attended (3+ vs 0 previous attendances) were more likely to have long wait (OR=1.07 (95% CI=1.06 to 1.08)), hospital admission (OR=1.10 (95% CI=1.09 to 1.12)) and ED attendance (OR=3.13 (95% CI=3.09 to 3.17)). Those who attended out of hours (vs not out of hours) were more likely to have a long ED wait (OR=1.33 (95% CI=1.32 to 1.34)), be admitted to hospital (OR=1.19 (95% CI=1.18 to 1.21)) and have ED reattendance (OR=1.07 (95% CI=1.05 to 1.08)). Those living in less deprived decile (vs most deprived decile) were less likely to have any of these three

outcomes:

OR=0.93 (95% CI=0.92 to 0.95), 0.92 (95% CI=0.90 to 0.94), 0.86 (95% CI=0.84 to 0.88). These characteristics were not strongly associated with long waits for those who arrived by ambulance. Emergency call handler designation was the strongest predictor of long ED waits and hospital admission compared with those who did not arrive by ambulance; ORs for these outcomes were 1.18 (95% CI=1.16 to 1.20) and 1.85 (95% CI=1.81 to 1.89) for those designated less urgent; 1.37 (95% CI=1.33 to 1.40) and 2.13 (95% CI=2.07 to 2.18) for urgent attendees; 1.26 (95% CI=1.23 to 1.28) and 2.40 (95% CI=2.36 to 2.45) for emergency attendees; and 1.37 (95% CI=1.28 to 1.45) and 2.42 (95% CI=2.26 to 2.59) for those with life-threatening conditions. We identified two EDs whose patients were less likely to have a long ED, hospital admission or ED reattendance than other EDs in the region.

CONCLUSIONS:

Age, previous attendance and attending out of hours were all associated with an increased likelihood of exceeding 4 hours in the ED, hospital admission and reattendance among patients over 75 years. These differences were less pronounced among those arriving by ambulance. Emergency call handler designation could be used to identify those at the highest risk of long ED waits, hospital admission and ED reattendance.
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Listas de Espera / Hospitalización Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Humans Idioma: En Año: 2023 Tipo del documento: Article

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Listas de Espera / Hospitalización Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Humans Idioma: En Año: 2023 Tipo del documento: Article