Explore the vast range of titles available.

PurposeAvoiding unnecessary emergency admissions and managing those that are admitted more effectively is a major concern for both patients and health services. To generate evidence useful for improving services for direct patient benefit, this study explores service users’ views and experiences of emergency admissions and subsequent inpatient care.MethodsParticipants were recruited during a cancer-related emergency admission from a tertiary cancer centre with an emergency oncology service and emergency department. Semi-structured interviews were conducted with 15 patients and 12 carers post hospital discharge. Interview transcripts were analyzed using framework analysis.ResultsTwenty patients experienced 43 emergency admissions over 6 months. Most admissions (35/43) followed patients presenting acutely or as emergencies with cancer treatment side effects. Most admissions (35/43) were directly to an oncology ward following specialist advice, review and triage, and thus unavoidable. Participants experienced outstanding inpatient care because of the following: prompt and effective symptom control and stabilization of acute conditions; continuity of cancer care and coordination between acute and long-term treatment; satisfactory professional-patient communication and information sharing; responsive, motivated and competent staff; and less restrictive visiting times. Gaps in care were identified.ConclusionsMany emergency admissions are necessary for people with cancer. Future work should focus on improving easy access to specialist advice and triage, and the process of admission; providing rapid palliation of symptoms and prompt stabilization of acute conditions, and satisfactory inpatient care; closing the circle of care for patients by actively involving primary care and palliative/end-of-life care services to address the complex needs of patients and carers.

As hospital beds are scarce, and emergency admissions to a psychiatric ward are major life-events for children and adolescents, it is essential to have insight into the decision-making process that leads to them. To identify potentially modifiable factors, we, therefore, studied the contextual and clinical characteristics associated with the voluntary and compulsory emergency admission of minors. We used registry data (2008–2017) on 1194 outpatient emergencies involving children aged 6–18 who had been referred to the mobile psychiatric emergency service in two city areas in The Netherlands. Demographic and contextual factors were collected, as well as clinical characteristics including diagnoses, psychiatric history, Global Assessment of Functioning (GAF), and the Severity of Psychiatric Illness (SPI) scale. Logistic regression analyses were used to identify factors that predict voluntary or compulsory admission. Of 1194 consultations, 227 (19.0%) resulted in an admission, with 137 patients (11.5%) being admitted voluntarily and 90 (7.5%) compulsorily. Independently of legal status, the following characteristics were associated with admission: severity of psychiatric symptoms, consultation outside the patient’s home, and high levels of family disruption. Relative to voluntary admission, compulsory admission was associated with more severe psychiatric problems, higher suicide risk, and prior emergency compulsory admission. Two potentially modifiable factors were associated with psychiatric emergency admission: the place where patients were seen for consultation, and the presence of family problems. Psychiatric emergency admissions may be reduced if, whenever possible, minors are seen in their homes and if a system-oriented approach is used.

Purpose Compared to others, patients diagnosed with lung cancer following an emergency, unplanned admission to hospital (DFEA) have more advanced disease and poorer prognosis. Little is known about DFEA patients’ beliefs about cancer and its symptoms or about their help-seeking behaviours prior to admission. Methods As part of a larger single-centre, prospective mixed-methods study conducted in one University hospital, we undertook qualitative interviews with patients DFEA and their carers to obtain their understanding of symptoms and experiences of trying to access healthcare services before admission to hospital. Interviews were recorded and transcribed. Framework analysis was employed. Results Thirteen patients and 10 carers plus 3 bereaved carers took part in interviews. Three patient/carer dyads were interviewed together. Participants spoke about their symptoms and why they did not seek help sooner. They described complex and nuanced experiences. Some ( n  = 12) had what they recalled as the wrong symptoms for lung cancer and attributed them either to a pre-existing condition or to ageing. In other cases ( n  = 9), patients or carers realised with hindsight that their symptoms were signs of lung cancer, but at the time had made other attributions to account for them. In some cases ( n  = 3), a sudden onset of symptoms was reported. Some GPs ( n  = 6) were also reported to have made incorrect attributions about cause. Conclusion Late diagnosis meant that patients DFEA needed palliative support sooner after diagnosis than patients not DFEA. Professionals and lay people interpret health and illness experiences differently.

Hospital-acquired acute kidney injury (H-AKI) is a common cause of avoidable morbidity and mortality. Therefore, in the current study, we investigated whether vital signs data from patients, as defined by a National Early Warning Score (NEWS), can predict H-AKI following emergency admission to hospital. We analysed all emergency admissions (n=33,608) to York Hospital with NEWS data over a 24-month period. Here, we report the area under the curve (AUC) for logistic regression models that used the index NEWS (model A0), plus age and sex (A1), plus subcomponents of NEWS (A2) and two-way interactions (A3), and similarly for maximum NEWS (models B0,B1,B2,B3). Of the total emergency admissions, 4.05% (1,361/33,608) had H-AKI. Models using the index NEWS had lower AUCs (0.59–0.68) than models using the maximum NEWS AUCs (0.75–0.77). The maximum NEWS model (B3) was more sensitive than the index NEWS model (A0) (67.60% vs 19.84%) but identified twice as many cases as being at risk of H-AKI (9581 vs 4099) at a NEWS of 5. Based on these results, we suggest that the index NEWS is a poor predictor of H-AKI. The maximum NEWS is a better predictor but appears to be unfeasible because it is only knowable in retrospect and is associated with a substantial increase in workload, albeit with improved sensitivity.

This essay makes the case for increased use of patient-centred methodologies, which involve patients and the public, in the area of emergency admissions research in the United Kingdom. Emergency admission research has rarely made use of the patient voice when attempting to find a rate of ‘inappropriate’ admission for older people, instead focusing on professional viewpoints and more abstract tools. We argue for the important insights that patients and their families bring to emergency admissions research and for the need to listen to and use these voices to find more holistic responses to the issue of unplanned admissions to hospital for those aged over 65. This area of health services research is highly complex, but without involving the patient viewpoint we risk not understanding the full story of events leading up to admission and what preventative measures might have helped, and therefore we also risk developing less effective, simplistic solutions. In the face of increasing challenges to the National Health Service’s ability to provide safe, effective and affordable care for older people, researchers need to listen to those with direct and longitudinal experience of their ill health and admission.

Abstract Objective To determine the subsequent pattern of emergency admissions in older people with a history of frequent emergency admissions. Design Analysis of routine admissions data from NHS hospitals using hospital episode statistics (HES) in England. Subjects Individual patients aged  65,  75, and  85 who had at least two emergency admissions in 1997-8. Main outcome measures Emergency admissions and bed use in this “high risk” cohort of patients were counted for the next five years and compared with the general population of the same age. No account was taken of mortality as the analysis was designed to estimate the future use of beds in this high risk cohort. Results Over four to five years, admission rates and bed use in the high risk cohorts fell to the mean rate for older people. Although patients  65 with two or more such admissions were responsible for 38% of admissions in the index year, they were responsible for fewer than 10% of admissions in the following year and just over 3% five years later. Conclusion Patients with multiple emergency admissions are often identified as a high risk group for subsequent admission and substantial claims are made for interventions designed to avoid emergency admission in such patients. Simply monitoring admission rates cannot assess interventions designed to reduce admission among frail older people as rates fall without any intervention. Comparison with a matched control group is necessary. Wider benefits than reduced admissions should be considered when introducing intensive case management of older people.

To investigate the risk of emergency hospital admissions for violence (EHAV) associated with demographic and socioeconomic factors in Wales between 2007/2008 and 2013/2014, and to describe the site of injury causing admission. Database analysis of 7 years' hospital admissions using the Patient Episode Database for Wales (PEDW). Wales, UK, successive annual populations ∼2.8 million aged 0-74 years. The first emergency admission for violence in each year of the study, defined by the International Classification of Diseases V.10 (ICD-10) codes for assaults (X85-X99, Y00-Y09) in any coding position. A total of 11 033 admissions for assault. The majority of admissions resulted from head injuries. The overall crude admission rate declined over the study period, from 69.9 per 100 000 to 43.2 per 100 000, with the largest decrease in the most deprived quintile of deprivation. A generalised linear count model with a negative binomial log link, adjusted for year, age group, gender, deprivation quintile and settlement type, showed the relative risk was highest in age group 18-19 years (RR=6.75, 95% CI 5.88 to 7.75) compared with the reference category aged 10-14 years. The risk decreased with age after 25 years. Risk of admission was substantially higher in males (RR=4.55, 95% CI 4.31 to 4.81), for residents of the most deprived areas of Wales (RR=3.60, 95% CI 3.32 to 3.90) compared with the least deprived, and higher in cities (RR=1.37, 95% CI 1.27 to 1.49) and towns (RR=1.32, 95% CI 1.21 to 1.45) compared with villages. Despite identifying a narrowing in the gap between prevalence of violence in richer and poorer communities, violence remains strongly associated with young men living in areas of socioeconomic deprivation. There is potential for a greater reduction, given that violence is mostly preventable. Recommendations for reducing inequalities in the risk of admission for violence are discussed.

Whenever there are well-publicised pressures on acute care, there is a tendency for policy makers and the media to imply that a significant number of older people may be taking up hospital beds when they do not really need the services provided there. However, evidence to back up such claims is often lacking, and existing research tends to fail to engage meaningfully with older people themselves. In contrast, this research explores the emergency hospital admissions of older people in three English case study sites, drawing on the lived experience of older people and the practice wisdom of front-line staff to explore the appropriateness of each admission and scope for alternatives to hospital. Contrary to popular opinion, the study did not find evidence of large numbers of older people being admitted to hospital inappropriately. Indeed, some of the older people concerned delayed seeking help and only ended up at hospital as a very last resort, possibly due to concerns about being seen as a burden on scarce public resources. While older people and front-line staff identified a number of suggestions to improve services in future, there seemed few clear cut, easy answers to the longstanding dilemma of how best to reduce emergency admissions. Seeking to understand and potentially reduce emergency hospital admissions is complex, and it is important to consider the experiences and expertise of older people and front-line staff.

ABSTRACTObjective To investigate trends in the incidence of acute pancreatitis by examining emergency admissions to acute public hospitals over an 8-year period; to compare trends for alcohol-related pancreatitis admissions with biliary tract-related admissions and to profile the patients admitted with an acute pancreatitis diagnosis. Methods All in-patient emergency admissions for which an acute pancreatitis diagnosis (ICD-9-CM Code 577.0) was recorded as principal diagnosis were identified for years 1997–2004 inclusive. Alcohol-related acute pancreatitis admissions (i.e. had alcohol misuse recorded as co-morbidity) were identified using ICD-9-CM-codes 303 and 305. Biliary tract disease-related admissions (i.e. had biliary tract disease recorded as co-morbidity) were identified using ICD-9-CM codes 574.0–576.0 inclusive. Pearson's χ2-test was used to compare proportions in groups of categorical data and χ2-tests for trend were used to identify linear trends. Results There were 6291 emergency admissions with a principal diagnosis of acute pancreatitis during the 8 year study period, with 622 admissions in 1997 compared to 959 admissions in 2004, an increase of 54.1%. Age standardized rates rose significantly from 17.5 per 100 000 population in 1997 to 23.6 per 100 000 in 2004, (P < 0.01 for linear trend). There were 1205 admissions with alcohol misuse recorded as a co-morbidity increasing from 13.9% (87/622) of acute pancreatitis admissions in 1997 to 23.2% (223/959) in 2004. This increase was significantly greater than the increase observed for biliary tract disease-related admissions, 19.6% (122/622) in 1997 to 23.5% (225/959) in 2004. Rates for total acute pancreatitis admissions were highest in those aged 70 years and over; the majority (3563, 56.6%) of the admissions were male with a mean age of 51.1 years (SD 19.9); the mean age for male admissions was significantly younger than for female admissions (49.1 versus 53.6 years, P < 0.001). However, for alcohol-related admissions, rates were highest in those aged 30–49 years and patients admitted with alcohol misuse recorded were significantly younger than those who did not have alcohol misuse recorded (42.0 versus 53.2 years, P < 0.001). Median length of stay was 7 days. Conclusions Hospital admissions for acute pancreatitis rose from 17.5 per 100 000 population in 1997 to 23.6 per 100 000 in 2004. The proportion of admissions that had alcohol misuse recorded as a co-morbidity rose more markedly than those with biliary tract disease and the rise was more pronounced in younger age groups. The increasing trend in alcohol-related acute pancreatitis parallels the rise in per capita alcohol consumption. Given the continuing rise in binge drinking, particularly among young people, this is a cause for concern.

Longitudinal studies of patterns of healthcare contacts in those who die by suicide to identify those at risk are scarce. To examine type and timing of healthcare contacts in those who die by suicide. A population-based electronic case-control study of all who died by suicide in Wales, 2001-2017, linking individuals' electronic healthcare records from general practices, emergency departments and hospitals. We used conditional logistic regression to calculate odds ratios, adjusted for deprivation. We performed a retrospective continuous longitudinal analysis comparing cases' and controls' contacts with health services. We matched 5130 cases with 25 650 controls (5 per case). A representative cohort of 1721 cases (8605 controls) were eligible for the fully linked analysis. In the week before their death, 31.4% of cases and 15.6% of controls contacted health services. The last point of contact was most commonly associated with mental health and most often occurred in general practices. In the month before their death, 16.6 and 13.0% of cases had an emergency department contact and a hospital admission respectively, compared with 5.5 and 4.2% of controls. At any week in the year before their death, cases were more likely to contact healthcare services than controls. Self-harm, mental health and substance misuse contacts were strongly linked with suicide risk, more so when they occurred in emergency departments or as emergency admissions. Help-seeking occurs in those at risk of suicide and escalates in the weeks before their death. There is an opportunity to identify and intervene through these contacts.