Aims

To generate the knowledge needed to develop and improve pathways to avoid emergency hospital admission and to identify patients who are suitable for same day emergency care, so they do not have to spend longer than necessary in hospital.

Background

Emergency hospital admissions in the UK have been rising steadily, and medical emergencies are the most common cause for patients being admitted to hospital as an emergency.

Some patients can be assessed, treated and discharged home by the medical team within the same day and do not require hospital admission overnight. Same Day Emergency Care (SDEC) helps patients avoid admission to hospital and can help reduce unnecessary waiting in hospital, while still providing the assessment and treatment that is needed for their medical problem. Both of these have previously been identified as a priority for patients. Avoiding admission also reduces demand for inpatient hospital beds and helps to improve crowding in emergency and acute services, which can have an impact on patient safety.

Research

This project will use data from patients that have been assessed, treated and discharged from hospital within 48 hours of arriving at the hospital, to help us understand how to improve Same Day Emergency Care.

We will use data that is collected as part of usual clinical care, and stored within electronic health records, to describe the diagnostic tests and admission pathways, for patients that have previously had an inpatient hospital admission to the medical team that lasted less than 24 hours, and for those whose admission lasted 24-48 hours. This will help us work out how to improve these pathways by providing new insight regarding where we are currently delivering SDEC successfully.

By assessing those admissions that last a few hours, for example where patients are waiting for specific tests, we will identify alternative pathways that could be trialled to avoid admission to acute medical units for these patients, such as providing urgent access to these tests as an outpatient.

By assessing where admissions lasted 24-48 hours, we will identify groups of patients where admission to inpatient hospital beds overnight could have been avoided if current services were adapted. This may be those with medical problems who are kept overnight for review by a different medical specialty, or for scans or other investigations.

Patient involvement

A lay summary of findings will be produced with the research team’s patient contributors. Results will be used to develop further research/improvement projects, which will also be discussed with patients and members of the public.

Approval

This project was supported unanimously by the PIONEER Data Trust Committee.

Principal investigator

Dr Catherine Atkin, University of Birmingham

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