Antoni Juan

Effectiveness and safety of an emergency department short-stay unit as an alternative to standard inpatient hospitalisation

Background: Emergency department short-stay units (EDSSUs) are currently emerging worldwide as an alternative to standard inpatient hospitalisation. In our hospital, a 960-bed teaching tertiary institution in Barcelona, Spain, an EDSSU has been in operation during winter periods (November–March) since 1997. Aim: To determine the efficacy and safety of our EDSSU. Methods: Retrospective analysis of activity and quality outcomes, assessment of patient satisfaction levels and determination of the diagnostic-related groups that were mainly responsible for admissions to the EDSSU, comparing the clinical characteristics of those patients with the characteristics of patients with similar clinical diagnoses admitted to standard hospitalisation units. Results: 5666 patients were treated in the EDSSU, with a progressive increase in the number of patients admitted per period, ranging from 707 in 1997–8 to 1227 in 2003–4 (73.5% increase). The mean length of stay ranged from 3.1 to 2.8 days, mortality from 2.5% to 5.1%, home discharge rate from 84% to 90%, and hospital readmission rate within the first week after discharge from 3.9% to 6.2%. In all, 98% of patients were satisfied with their stay at the EDSSU. The main diagnostic-related groups were chronic obstructive pulmonary disease (COPD = 50%) and acute heart failure (28%). Patients with COPD admitted at the EDSSU (n = 545) showed significantly (p = 0.05) lower mean length of stay (3.4 v 12 days) and mortality (1.7% v 8.1%), but a higher hospital readmission rate (9.9% v 7%) than those admitted to standard inpatient units (n = 1961). Conclusions: In our experience, the EDSSU proved to be an effective and safe alternative to standard inpatient hospitalisation.

High mortality rates from medical problems of frequent emergency department users at a university hospital tertiary care centre.

Background: Frequent emergency department (ED) users are a nebulous group of patients. A high degree of psychiatric problems and higher than expected mortality from medical illness have been reported in this population. Study objectives: We sought to examine the pattern of ED use by adult patients identified as being heavy users of the ED, to examine their demographic characteristics and describe their clinical profile during a one-year period at one institution. Methods: This was a descriptive, retrospective study that took place in the ED of a 1000-bed teaching hospital in Barcelona, Spain, with a population in the metropolitan area of 1.5 million, which attends approximately 110 000 emergency visits per year, excluding paediatrics and obstetrics. The ED computer registration database was used to identify all patients presenting to the hospital ED more than 10 times in a one-year period from 1 January to 31 December 2000. A cohort composed of 86 patients fitting these inclusion criteria was identified as making 1263 (1.1%) of the total 109 857 ED visits. All medical records for each patient were reviewed to determine the primary reason for repeated ED visits. Results: Of the 86 patients enrolled, 58 were men (67.4%). The mean age was 55 years (range 18–91), but only six patients (6.9%) were older than 80 years. The median number of ED visits per patient was 14 throughout the year. Forty-five of the patients (52.3%) were classified as having primarily medical reasons for presenting to the ED, with diagnoses such as shortness of breath and chest pain being the chief symptoms. Seventeen patients (19.7%) had a surgical problem as the cause of their ED visits, and eight (9.3%) had psychiatric problems contributing to the ED visits. Other major reasons for presentation to the ED were as follows: ophthalmic, eight patients (9.3%); otolaryngological, four patients (4.6%); and trauma, four patients (4.6%). A total of 982 (77.8%) of the total ED visits resulted in home discharge. Hospital emergency admissions and outpatient clinics diversions occurred in 106 (8.3%) and 71 (5.6%) ED visits, respectively. The mortality rate was as high as 18.6% (16 frequent ED users died). Conclusion: These data show that there is a high incidence of medical problems in frequent ED users and a high incidence of mortality in patients with heavy ED use.

Experience of the moving day of a general hospital and effect on clinical activity

OBJECTIVES: To describe the moving day of a general hospital and to analyze the impact on clinical activity in the first few months after the move. METHODS: We describe the process of patient transfer and analyze the impact on activity of moving a regional general hospital in Catalonia (Spain) to a new building. Activity was compared in two periods: the first 3 months after the move (period 2) and the same 3 months in the previous year (period 1). RESULTS: We moved 37 patients without incidents. A total of 18,786 patients were admitted to the emergency room in period 1 and 21,266 were admitted in period 2 (+13.2%). The number of admissions from the emergency room vs elective admissions was 1,314/803 in period 1 and 1,427/979 in period 2 (+8.59%/ +21.91%). The number of outpatient visits in period 1 was 32,116 and 30,777 in period 2 (-4.16%). CONCLUSIONS: Proper planning and coordination allowed the hospital to be moved without incidents and without decreasing activity.

Experiencia acerca del traslado de un hospital general y su repercusión en la actividad asistencial

OBJECTIVES To describe the moving day of a general hospital and to analyze the impact on clinical activity in the first few months after the move. METHODS We describe the process of patient transfer and analyze the impact on activity of moving a regional general hospital in Catalonia (Spain) to a new building. Activity was compared in two periods: the first 3 months after the move (period 2) and the same 3 months in the previous year (period 1). RESULTS We moved 37 patients without incidents. A total of 18,786 patients were admitted to the emergency room in period 1 and 21,266 were admitted in period 2 (+13.2%). The number of admissions from the emergency room vs elective admissions was 1,314/803 in period 1 and 1,427/979 in period 2 (+8.59%/ +21.91%). The number of outpatient visits in period 1 was 32,116 and 30,777 in period 2 (-4.16%). CONCLUSIONS Proper planning and coordination allowed the hospital to be moved without incidents and without decreasing activity.