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ORIGINAL ARTICLE |
1 Departments of Infectious Disease and General Medicine, Royal Victoria Hospital, and General Internal Medicine, Belfast City Hospital, Belfast, UK
2 General Internal Medicine, Belfast City Hospital, Belfast, UK, Therapeutics and Pharmacology, Trinity College Dublin, Trinity Centre, and Division of Internal Medicine, St James’ Hospital, Dublin, Ireland
3 Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Centre, and Division of Internal Medicine, St James’ Hospital, Dublin, Ireland
4 General Internal Medicine, Belfast City Hospital, Belfast, UK
Correspondence to:
Correspondence to:
Dr B Silke
Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James’ Hospital, James’ Street, Dublin 8, Ireland; silkeb{at}tcd.ie
Objectives: To describe the patient demographic characteristics and organisational factors that influence length of stay (LOS) among emergency medical admissions. Also, to describe differences in investigation practice among consultant physicians and to examine the impact of these on LOS.
Design: Prospective observational study.
Setting: General medicine department of a teaching hospital in Belfast, UK.
Participants: Data were recorded for patients who were admitted as emergencies and reviewed on the post-take ward rounds (PTWR) attended by the investigation coordinator.
Outcome measures: Non-laboratory investigations requested, LOS, and diagnosis on discharge.
Results: Of 830 episodes evaluated, the median LOS was 7 days (interquartile range 3–12 days); this was significantly longer for admissions on Fridays (p = 0.0011) and for patients managed on medical wards (p<0.0001). There was a positive correlation between patient age and LOS (r = 0.32, p<0.0001). Chest radiographs (p = 0.002) and echocardiography (p = 0.015) were associated with a prolonged LOS; no investigations were associated with a shortened LOS. Diagnoses of congestive heart failure, respiratory disease, and cancer were associated with a longer LOS; a diagnosis of angina was associated with a shorter LOS. Considerable variation in investigation ordering, but no difference in LOS, was observed between consultants. High use of a given medical test did not correlate with high use of other tests.
Conclusion: A systematic means of dealing with the NHS resource crisis should include an improved organisational strategy as well as social care provision. A more unified approach to investigation practice should also have a sparing effect on resources.
Keywords: resource utilisation; length of hospital stay; pattern of investigation; acute medical hospital admission
Abbreviations: DVT, deep vein thrombosis; ECG, electrocardiography; IQR, interquartile range; LOS, length of stay; PTWR, post-take ward round
This article has been cited by other articles:
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  E Sibly, C M Wiskin, R L Holder, and M W Cooke Short stay emergency admissions to a West Midlands NHS Trust: a longitudinal descriptive study, 2002 2005 Emerg. Med. J., August 1, 2007; 24(8): 553 - 557. [Abstract] [Full Text] [PDF]
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 P. Leman Emergency care in the first 48 hours BMJ, February 3, 2007; 334(7587): 218 - 219. [Full Text] [PDF]
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 A unified approach to clinical testing in acute medical admissions may protect health resources Qual. Saf. Health Care, August 1, 2004; 13(4): 305 - 305. [Full Text] [PDF]
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