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Journal articles on the topic 'Acute medical admissions'

Author: Grafiati

Published: 4 June 2021

Last updated: 14 February 2022

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1

Perkins, C., F. Ray Brown, K. Pohl, O. McLaren, J. Powles, and R. Thorley. "Implementing a guideline for acute tonsillitis using an ambulatory medical unit." Journal of Laryngology & Otology 133, no. 05 (April 10, 2019): 386–89. http://dx.doi.org/10.1017/s0022215119000380.

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AbstractObjectiveAcute tonsillitis represents a significant proportion of admissions to ENT departments nationally. Given current hospital pressures, it is vital to look for safe alternatives to admission. This study explores the safe management of patients in an ambulatory medical unit, without the need for admission.MethodsA retrospective review of 48 patients’ notes was carried out. Following the development and implementation of a guideline for acute tonsillitis, a prospective re-audit of 41 patients was carried out, measuring length of stay, overnight admissions and re-admissions.ResultsThe rate of overnight admission following implementation of the guideline fell from 0.75 to 0.29, and average length of stay dropped from 19.2 to 9.5 hours. There were two re-admissions in each cycle of the audit, which represents a non-significant increase.ConclusionThe tonsillitis guideline has significantly reduced admissions and length of stay. Re-admissions remain low, demonstrating that this is a safe and cost-effective intervention.

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2

Forbes, Raeburn, John Craig, Michael Callender, and Victor Patterson. "Liaison neurology for acute medical admissions." Clinical Medicine 4, no. 3 (May 1, 2004): 290. http://dx.doi.org/10.7861/clinmedicine.4-3-290.

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3

Hider, P., J. O'Hagan, S. Bidwell, and R. Kirk. "The rise in acute medical admissions." Australian and New Zealand Journal of Medicine 30, no. 2 (April 2000): 252–60. http://dx.doi.org/10.1111/j.1445-5994.2000.tb00816.x.

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4

Spencer, B., L. Fook, P. Mcdonald, and C. J. Turnbull. "Acute Medical Admissions from Nursing Homes." Age and Ageing 27, suppl 1 (January 1, 1998): P46. http://dx.doi.org/10.1093/ageing/27.suppl_1.p46-c.

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5

Shah, S., S. Coppack, and J. Emmanuel. "Identifying obesity in acute medical admissions." Appetite 91 (August 2015): 436. http://dx.doi.org/10.1016/j.appet.2015.04.030.

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6

Westall, Christopher, Robert Spackman, Channa Vasanth Nadarajah, and Nicola Trepte. "Are hospital admissions reduced by Acute Medicine consultant telephone triage of medical referrals?" Acute Medicine Journal 14, no. 1 (January 1, 2015): 10–13. http://dx.doi.org/10.52964/amja.0405.

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The NHS in England is facing well-documented pressures related to increasing acute hospital admissions at a time when the acute medical bed-base is shrinking, doctors working patterns are increasingly fragmented and many acute hospital trusts are operating a financial deficit. Novel strategies are required to reduce pressure on the acute medical take. We conducted a prospective cohort study to assess the impact of acute medicine consultant triage of referrals to the acute medical take on the number of acute hospital admissions as compared to a historical control cohort. The introduction of an acute medicine consultant telephone triage service was associated with a 21% reduction in acute medical admissions during whole the study period. True admission avoidance was achieved for 28.5% of referrals triaged by an acute medicine consultant. The greatest benefit was seen for consultant-triage of GP referrals; 43% of all GP referrals resulted in a decision not to admit and in 25% the referral was avoided by giving advice alone. Consultant telephone triage of referrals to the acute medical take substantially reduces the number of acute medical admissions as compared to triage by a trained band 6 or higher nurse coordinator. Our service is cost effective and can be job-planned using 6 full-time equivalent acute medicine consultants. The telephone triage service also provides additional benefits to admission numbers beyond its hours of operation and the general management of the acute medical take.

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7

Thompson, A., M. Stevens, I. Collin, and N. Wennike. "Evolving sepsis definitions and their impact on Acute Medical Units." Acute Medicine Journal 16, no. 1 (January 1, 2017): 25–29. http://dx.doi.org/10.52964/amja.0648.

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Background: There are currently several different definitions for sepsis. This study looked at what proportion of acute medical admissions were identified by the different definitions, what correlation they have, and how many patients would require a review with results in 1 hour. Methods: Data on 212 admissions was collected, on time of admission and review, and number of patients with sepsis by each diagnostic criteria calculated. Results: The NICE criteria identified 69% of admissions as requiring review within one hour, compared to 6% with qSOFA and 18% with previous sepsis definitions. The mean time to review was 1hr 18min, and only 50% of patients meeting the NICE criteria were reviewed within one hour. Conclusions: The proposed NICE guidance will be challenging to implement with current resources.

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8

Summers, Shaun A., and Paul A. Glynne. "Acute poisoning on the medical admissions unit." Clinical Medicine 7, no. 3 (June 1, 2007): 277–79. http://dx.doi.org/10.7861/clinmedicine.7-3-277.

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9

O’Driscoll, Ronan, Nawar D. Bakerly, Peter Murphy, and Peter Turkington. "Re: SpO2 values in acute medical admissions." Resuscitation 84, no. 3 (March 2013): e49. http://dx.doi.org/10.1016/j.resuscitation.2012.10.027.

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10

Jones, M., M. Kellett, and C. Murphy. "029 Neurology input for acute medical admissions." Journal of Neurology, Neurosurgery & Psychiatry 83, no. 3 (February 9, 2012): e1.193-e1. http://dx.doi.org/10.1136/jnnp-2011-301993.71.

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11

Canning, U. P. "Substance misuse in acute general medical admissions." QJM 92, no. 6 (June 1, 1999): 319–26. http://dx.doi.org/10.1093/qjmed/92.6.319.

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12

Woodard, J., J. Youde, B. Sutton, and S. Bagshaw. "39 * FRAILTY IDENTIFICATION IN ACUTE MEDICAL ADMISSIONS." Age and Ageing 43, suppl 1 (June 1, 2014): i9. http://dx.doi.org/10.1093/ageing/afu036.39.

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13

Muir, A., and S. Paul. "An audit of medical and nursing records of 100 emergency short-term (< 7 dys) psychiatric admissions to acute adult wards in Dumfries." European Psychiatry 26, S2 (March 2011): 748. http://dx.doi.org/10.1016/s0924-9338(11)72453-1.

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IntroductionThe study population is served by CMHTs and in addition (in one sector) by a Crisis and Home Treatment Team.ObjectivesTo evaluate the recorded admission and discharge processes in the medical and nursing notes.To record relevant clinical characteristics of the admission and the patient.AimsTo assess recorded admission and discharge processes against standards defined in the protocol.MethodsA random sample of 100 records, which met inclusion criteria, was selected. A protocol evaluating the recorded processes, and relevant information re the admission was completed by psychiatric trainees and senior nurses.Results51% of admissions occurred on week-ends and 58% occurred “out of hours”. In 35% of admissions a further admission had occurred within 4 weeks. 34% of admissions derived from 2 areas, highly correlated with deprivation. Alcohol or drug misuse contributed to 69% of admissions. In 77% of admissions, the patient was known to the service. 10% of patients had a diagnosis of major mental illness.Recorded medical and nursing assessments of admission were incomplete i.e. 66% of medical records and 80% of nursing records. Assessment of discharge records indicated similar failings in record -keeping.ConclusionsThe recurrent pattern of admissions(33%), the association with deprivation(34%) and drug or alcohol misuse(69%), indicate the need for more effective management of these patients. The failings in recording admission and discharge information are significant. Improvements in these processes could identify those patients who require additional support and /or are at risk of futher admissions.

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14

Mcknight, J. A., and C. Espie. "Managing Acute Medical Admissions: The Plight of the Medical Boarder." Scottish Medical Journal 57, no. 1 (February 2012): 45–47. http://dx.doi.org/10.1258/smj.2011.011187.

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15

Yang, Elizabeth, Anil Chalisey, Micheal E. Reschen, Brian Shine, Daniel Lasserson, and Christopher A. O’Callaghan. "Reduced kidney function at presentation in unselected acute emergency medical admissions: incidence, outcome and associated factors." Acute Medicine Journal 18, no. 3 (July 1, 2019): 158–64. http://dx.doi.org/10.52964/amja.0769.

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We sought to assess the impact of renal impairment on acute medical admissions and to identify potential contributory factors to admissions involving renal impairment at presentation. In a prospective cohort study, 29.5% of all acute medical emergency admissions had an eGFR < 60 ml/min/1.73m2 at presentation. Of these, 19.9 % had definite chronic kidney disease and 8.4 % had definite acute kidney injury. Detailed analysis of a random subset of patients with an eGFR <60ml/min/1.73m2 at presentation demonstrated that the major reasons for admission included falls, dehydration and fluid overload. 46% were on diuretics and 53% were on an ACEI or ARB or both. Gastrointestinal disturbance and recent medication changes were common and diuretic use persisted even with diarrhoea or vomiting.

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Lyons, J., S. H. Chotirmall, D. O'Riordan, and B. Silke. "Air quality impacts mortality in acute medical admissions." QJM 107, no. 5 (December 17, 2013): 347–53. http://dx.doi.org/10.1093/qjmed/hct253.

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17

Byrne, Declan G., Siok Li Chung, Kathleen Bennett, and Bernard Silke. "Age and outcome in acute emergency medical admissions." Age and Ageing 39, no. 6 (September 15, 2010): 694–98. http://dx.doi.org/10.1093/ageing/afq114.

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18

Reid, J., E. Dexter, M. Payne, and R. Brooks. "Appropriateness of Acute Medical Admissions in the Elderly." Age and Ageing 27, suppl 2 (January 1, 1998): 59. http://dx.doi.org/10.1093/ageing/27.suppl_2.59-b.

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19

Brennan, Michelle, Lorcan Mulkerrin, Deirdre Wall, Paula M. O'Shea, and Eamon C. Mulkerrin. "Suboptimal management of hypernatraemia in acute medical admissions." Age and Ageing 50, no. 3 (March 26, 2021): 990–95. http://dx.doi.org/10.1093/ageing/afab056.

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Abstract Background Hypernatraemia arises commonly in acute general medical admissions. Affected patients have a guarded prognosis with high rates of morbidity and mortality. Age-related physiology and physical/cognitive barriers to accessing water predispose older patients to developing hypernatraemia. This study sought to perform a descriptive retrospective review of hypernatraemic patients admitted under acute general medicine teams. Methods A retrospective cross-sectional study of a sample of acute medical in-patients with serum[sodium]>145 mmol/L was conducted. Patients were exclusively older(>69 years) and admitted from Nursing homes (NH)(41%) and non-NH pathways(59%). A comparison of management of NH /non-NH patients including clinical presentation, comorbidities, laboratory values, [sodium] monitoring, intravenous fluid regimes and patient outcomes was performed. Results In total, 102 consecutive patients (males, n=69(67.6%)) were included. Dementia and reduced mobility were more common in NH residents and admission serum [Sodium] higher (148 vs 142 mmol/L/p=0.003). Monitoring was inadequate: no routine bloods within the first 12h in >80% of patients in both groups. No patient had calculated free water deficit documented. More NH patients received correct fluid management (60% vs 33%/p%0.015). Incorrect fluid regimes occurred in both groups (38% vs 58%/p=0.070). Length of stay in discharged patients was lower in NH, (8(4-20) vs 20.5(9.8-49.3 days)/p=0.003). Time to death for NH residents was shorter (9(5.5-11.5) vs 16 (10.25-23.5) days/p=0.011). Conclusion This study highlights suboptimal management of hypernatraemia. Implementation of hypernatraemia guidelines for general medical older inpatients are clearly required with mechanisms to confirm adherence. Health care workers require further education on diagnostic challenges of dehydration in older people and the importance of maintaining adequate hydration.

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20

Dorward, A. "Changes in Patterns of Acute Medical Receiving in Scotland 1996 to 2001." Scottish Medical Journal 47, no. 5 (October 2002): 105–8. http://dx.doi.org/10.1177/003693300204700503.

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The purpose of this study was to review changes in working practises of physicians and hospitals from 1996 to 2001 in the light of rising medical admissions and published reports into the organisation of acute admissions. Information was gathered by direct discussion with the appropriate lead doctor for each hospital's acute service in February 2001. The results were compared with a previously published study, which recorded the situation as of October 1996. The hospitals which were studied were the twenty seven Scottish hospitals which admit more than 3000 acute medical patients each year. There has been a 25% increase in number of consultants carrying out receiving duties. Nearly all hospitals now have an acute admission unit. Four hospitals have appointed acute care physicians. Triage of appropriate patients to more specialised ward based care has increased. There has been a rise in geriatricians involvement in acute receiving from four to fifteen hospitals. New developments include early discharge for chronic obstructive airway disease, outpatient management of venous thrombosis, discharge planning and streamlining investigation of chest pain. Two hospitals have specific alcohol support services. There continues to be progress and changes within medical and geriatric services over the last five years stimulated by the continuing rise in number of medical admissions.

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21

Nwani, Paul Osemeke, Maduaburochukwu Cosmas Nwosu, and Monica Nonyelum Nwosu. "Epidemiology of Acute Symptomatic Seizures among Adult Medical Admissions." Epilepsy Research and Treatment 2016 (January 24, 2016): 1–5. http://dx.doi.org/10.1155/2016/4718372.

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Acute symptomatic seizures are seizures occurring in close temporal relationship with an acute central nervous system (CNS) insult. The objective of the study was to determine the frequency of presentation and etiological risk factors of acute symptomatic seizures among adult medical admissions. It was a two-year retrospective study of the medical files of adults patients admitted with acute symptomatic seizures as the first presenting event. There were 94 cases of acute symptomatic seizures accounting for 5.2% (95% CI: 4.17–6.23) of the 1,802 medical admissions during the period under review. There were 49 (52.1%) males and 45 (47.9%) females aged between 18 years and 84 years. The etiological risk factors of acute symptomatic seizures were infections in 36.2% (n=34) of cases, stroke in 29.8% (n=28), metabolic in 12.8% (n=12), toxic in 10.6% (n=10), and other causes in 10.6% (n=10). Infective causes were more among those below fifty years while stroke was more in those aged fifty years and above. CNS infections and stroke were the prominent causes of acute symptomatic seizures. This is an evidence of the “double tragedy” facing developing countries, the unresolved threat of infectious diseases on one hand and the increasing impact of noncommunicable diseases on the other one.

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22

Evans, Martin E., Loretta A. Simbartl, Stephen M. Kralovic, Rajiv Jain, and Gary A. Roselle. "Clostridium difficile Infections in Veterans Health Administration Acute Care Facilities." Infection Control & Hospital Epidemiology 35, no. 8 (August 2014): 1037–42. http://dx.doi.org/10.1086/677151.

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ObjectiveAn initiative was implemented in July 2012 to decrease Clostridium difficile infections (CDIs) in Veterans Affairs (VA) acute care medical centers nationwide. This is a report of national baseline CDI data collected from the 21 months before implementation of the initiative.MethodsPersonnel at each of 132 data-reporting sites entered monthly retrospective CDI case data from October 2010 through June 2012 into a central database using case definitions similar to those of the National Healthcare Safety Network multidrug-resistant organism/CDI module.ResultsThere were 958,387 hospital admissions, 5,286,841 patient-days, and 9,642 CDI cases reported during the 21-month analysis period. The pooled CDI admission prevalence rate (including recurrent cases) was 0.66 cases per 100 admissions. The nonduplicate/nonrecurrent community-onset not-healthcare-facility-associated (CO-notHCFA) case rate was 0.35 cases per 100 admissions, and the community-onset healthcare facility–associated (CO-HCFA) case rate was 0.14 cases per 100 admissions. Hospital-onset healthcare facility–associated (HO-HCFA), clinically confirmed HO-HCFA (CC-HO-HCFA), and CO-HCFA rates were 9.32, 8.40, and 2.56 cases per 10,000 patient-days, respectively. There were significant decreases in admission prevalence (P = .0006, Poisson regression), HO-HCFA (P = .003), and CC-HO-HCFA (P = .004) rates after adjusting for type of diagnostic test. CO-HCFA and CO-notHCFA rates per 100 admissions also trended downward (P = .07 and .10, respectively).ConclusionsVA acute care medical facility CDI rates were higher than those reported in other healthcare systems, but unlike rates in other venues, they were decreasing or trending downward. Despite these downward trends, there is still a substantial burden of CDI in the system supporting the need for efforts to decrease rates further.

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Murray, M., P. L. Padfield, and S. R. J. Maxwell. "Does a Hospital Formulary Influence Prescribing Practice in an Acute Medical Admissions Unit?" Scottish Medical Journal 50, no. 2 (May 2005): 76–79. http://dx.doi.org/10.1177/003693300505000212.

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Aim: To assess the extent to which prescribing of cardiovascular medications in a busy medical unit deviates from the local joint primary and secondary care drug formulary guidelines. Method: A retro spective audit of the case notes, prescription charts and discharge summaries oj 150 randomly selected emergency medical admissions overa 4 month period. Results: No patient receiving a non-formulary cardiovascular drug on admission had the choice reviewed in line with formulary recommendations. One third of new cardiovascular medications commenced in hospital were not compliant with formulary recommendations. Decisions about drug therapy were rarely justified in the written hospital record. Conclusions: Our results demonstrate that in a busy acute medical admissions' unit there is a clear jailure to amendor query non formulary prescribing at the time of admission and a tendency to exacerbate it during theinpatient period. This potentially undermines the purpose of a joint drug formulary as a guideline for safe, evidence-based and cost-effective prescribing.

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Cournane, Seán, Richard Conway, Declan Byrne, Deirdre O’Riordan, and Bernard Silke. "Predicting Outcomes in Emergency Medical Admissions Using a Laboratory Only Nomogram." Computational and Mathematical Methods in Medicine 2017 (2017): 1–8. http://dx.doi.org/10.1155/2017/5267864.

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Background. We describe a nomogram to explain an Acute Illness Severity model, derived from emergency room triage and admission laboratory data, to predict 30-day in-hospital survival following an emergency medical admission. Methods. For emergency medical admissions (96,305 episodes in 50,612 patients) between 2002 and 2016, the relationship between 30-day in-hospital mortality and admission laboratory data was determined using logistic regression. The previously validated Acute Illness Severity model was then transposed to a Kattan-style nomogram with a Stata user-written program. Results. The Acute Illness Severity was based on the admission Manchester triage category and biochemical laboratory score; these latter were based on the serum albumin, sodium, potassium, urea, red cell distribution width, and troponin status. The laboratory admission data was predictive with an AUROC of 0.85 (95% CI: 0.85, 0.86). The sensitivity was 94.4%, with a specificity of 62.7%. The positive predictive value was 21.2%, with a negative predictive value of 99.1%. For the Kattan-style nomogram, the regression coefficients are converted to a 100-point scale with the predictor parameters mapped to a probability axis. The nomogram would be an easy-to-use tool at the bedside and for educational purposes, illustrating the relative importance of the contribution of each predictor to the overall score. Conclusion. A nomogram to illustrate and explain the prognostic factors underlying an Acute Illness Severity Score system is described.

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Barwise-Munro, Rebecca, Heather Morgan, and Steve Turner. "Physician and Parental Decision—Making Prior to Acute Medical Paediatric Admission." Healthcare 6, no. 3 (September 17, 2018): 117. http://dx.doi.org/10.3390/healthcare6030117.

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Background: The number of acute medical paediatric emergency admissions is rising. We undertook qualitative interviews with parents and clinicians to better understand what factors, other than the health status of the child, may influence decision making leading to emergency admission. Methods: Semi-structured interviews were conducted with parents; clinicians working in general practice, out-of-hours or the emergency department (referring clinicians); and doctors working in acute medical paediatrics (receiving clinicians). Results: Ten parents, 7 referring clinicians and 10 receiving clinicians were interviewed. Parents described “erring on the side of caution” when seeking medical opinion and one mentioned anxiety. Among themes seen among referring clinicians, “erring on the side of caution” was also identified as was managing “parental anxiety” and acting on “gut instinct”. Among receiving clinicians, themes included managing parental anxiety and increasing parental expectations of the health service. Conclusions: The study of parent and referring clinician decision-making prior to a hospital admission can identify “teachable moments” where interventions might be delivered to slow or even arrest the rise in short-stay acute medical admissions in Britain and other countries. Interventions could assure parents or referring clinicians that hospital referral is not required and help clinicians understand what they perceive as “parental anxiety”.

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Newnham, Harvey H., Campbell H. Thompson, Paul F. Jenkins, and Lauri T. O’Brien. "Acute medical admissions in our hospitals: getting it right." Medical Journal of Australia 191, no. 1 (July 2009): 9–10. http://dx.doi.org/10.5694/j.1326-5377.2009.tb02665.x.

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27

Trevett, A. J., N. M. Currie, and T. J. MacConnell. "Alcohol Intoxication and Alcoholism in Acute Male Medical Admissions." Scottish Medical Journal 35, no. 5 (October 1990): 134–35. http://dx.doi.org/10.1177/003693309003500503.

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28

Constable, Simon, Andrew Ham, and Munir Pirmohamed. "Herbal medicines and acute medical emergency admissions to hospital." British Journal of Clinical Pharmacology 63, no. 2 (February 2007): 247–48. http://dx.doi.org/10.1111/j.1365-2125.2006.02817.x.

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29

Gordon, Alison, Hilda Hu, Anthony Byrne, and David J. Stott. "Dementia screening in acute medical and geriatric hospital admissions." Psychiatric Bulletin 33, no. 2 (February 2009): 52–54. http://dx.doi.org/10.1192/pb.bp.107.016550.

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Aims and MethodWe studied a representative cohort of 161 patients over 65 years of age, admitted non-electively to medical and geriatric wards of a large teaching hospital. Assessment for dementia was made using DSM–IV criteria. Psychiatric records were then examined, masked, to determine the involvement of psychogeriatric services.ResultsThere were 111 possible cases of dementia (69%), of which 30 (27%) had prior local psychogeriatric case notes; in 22 cases (20%) the patient had a prior psychiatric diagnosis of dementia. of 161 patients, 19 (12%) were seen by psychogeriatric services during their admission, of whom 12 (7%) were already known to psychiatric services. Dementia was diagnosed in 17 (complicated by delirium in 2), depression in 1 and hypomania in 1. Many patients with a possible diagnosis of dementia had no psychiatric assessment.Clinical ImplicationsPsychogeriatric assessment was performed on a minority of older people admitted to medical care. This population may include older people with undiagnosed dementia and unmet psychiatric care needs.

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Romero-Ortuno, Roman, Clodagh O’Dwyer, Declan Byrne, Deirdre O’Riordan, and Bernard Silke. "A Risk Index for Geriatric Acute Medical Admissions (RIGAMA)." Acute Medicine Journal 13, no. 1 (January 1, 2014): 6–11. http://dx.doi.org/10.52964/amja.0331.

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Aim: to create and validate a Risk Index for Geriatric Acute Medical Admissions (RIGAMA) for those aged ≥ 65, based on accumulation of deficits. Methods: we retrospectively validated a 30-item RIGAMA against inpatient mortality, length of stay (LOS), discharge to long-term care (LTC) and 30-day readmission, adjusted for age. Results: ≥ 1 RIGAMA deficit was superior to age in predicting mortality and prolonged LOS, with a clear incremental effect. The latter was true for ≥3 deficits in predicting 30-day readmission. Three to 5 deficits predicted discharge to LTC better than age. Conclusion: RIGAMA is easy to collect by the admitting junior doctor and may help trigger early senior support and inform the appropriate use of hospital resources by older patients.

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Fung, Chee Yeen, Zhin Ming Tan, Adam Savage, Mahdi Rahim, Fatima Osman, Mohammed Adnan, Emilia Peleva, and Amir H. Sam. "Undergraduate exposure to patient presentations on the acute medical placement: a prospective study in a London teaching hospital." BMJ Open 10, no. 11 (November 2020): e040575. http://dx.doi.org/10.1136/bmjopen-2020-040575.

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ObjectivesTo identify the availability and variability of learning opportunities through patient presentations on an acute medical placement at a teaching hospital.DesignA prospective study evaluating all acute admissions to the Acute Medical Unit over 14 days (336 hours). Clinical presentations and the day and time of admission were recorded and compared with the learning outcomes specified in the medical school curriculum.SettingAn Acute Medical Unit at a London teaching hospital.Outcomes(1) Number of clinical presentations to the Acute Medical Unit over 14 days and (2) differences between the availability and variation of admissions and presentations between in-hours and out-of-hours.ResultsThere were 359 admissions, representing 1318 presentations. Of those presentations, 76.6% were admitted out-of-hours and 23.4% in-hours. Gastrointestinal bleeding, tachycardia, oedema and raised inflammatory markers were over three times more common per hour out-of-hours than in-hours. Hypoxia was only seen out-of-hours. Important clinical presentations in the curriculum such as chest pain and hemiparesis were not commonly seen.ConclusionsThere is greater availability of presentations seen out-of-hours and a changing landscape of presentations seen in-hours. The out-of-hours presentation profile may be due to expanded community and specialist services. Medical schools need to carefully consider the timing and location of their clinical placements to maximise undergraduate learning opportunities.

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32

Draper, Brian. "The Elderly Admitted to a General Hospital Psychiatry Ward." Australian & New Zealand Journal of Psychiatry 28, no. 2 (June 1994): 288–97. http://dx.doi.org/10.1080/00048679409075641.

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In this retrospective study of 489 consecutive elderly admissions to a general hospital psychiatry ward, the main aim was to describe the stressors precipitating admission, psychiatric and medical diagnoses, physical treatments used, length of hospitalisation, and clinical and social outcome. Depression was the predominant diagnosis, with length of stay being correlated with depression severity. The main stressor associated with admissions was a change in medical status of the patient. At least two medical diagnoses were present in 70% of admissions, with many new physical illnesses being diagnosed. Significant improvement was found in 81% of admissions at discharge. Two thirds of admissions were discharged into independent living arrangements. While these outcomes suggested effective interventions, management difficulties were noted with the mix of elderly and young patients. It is recommended that acute psychogeriatric wards be developed in the general hospital and be located near geriatric medical wards.

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Cortes, Margarida Barreto, Samuel Raimundo Fernandes, Patricia Aranha, Luís Brito Avô, and Luís Menezes Falcão. "Association Between Weekend and Holiday Admission with Pneumonia and Mortality in a Tertiary Center in Portugal: A Cross-Sectional Study." Acta Médica Portuguesa 30, no. 5 (May 31, 2017): 361. http://dx.doi.org/10.20344/amp.8029.

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Introduction: Acute bacterial pneumonia is a common and potentially fatal disease where early recognition and treatment are crucial. Increasing medical literature suggests worse outcomes in patients admitted for medical and surgical conditions during the weekend. Little is known about this effect in patients with acute bacterial pneumonia.Objective: The aim of this study was to evaluate the impact of weekend and holiday hospital admission on the outcomes of acute bacterial pneumonia.Material and Methods: Retrospective analysis of adult patients (> 18 years) with acute bacterial pneumonia collected from a tertiary referral center database. Length of stay, total cost, admission to intensive care unit, development of sepsis and organ failure, and mortality were compared between patients admitted on a weekday and patients admitted during a weekend or holiday.Results: We analyzed 53 854 hospital admissions from 42 512 patients (median age 84.0 years, range 18 - 118 years), corresponding to 30 554 admissions during weekdays, 21 222 at weekends and 2078 during public holidays. Weekend and holiday admission was not associated with increased costs, length of stay, intensive care unit admission, development of sepsis, organ failure, and mortality.Conclusion: A weekend/holiday effect in acute bacterial pneumonia was not evident in our series.

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Krüger, Kjell, Kristian Jansen, Anders Grimsmo, Geir Egil Eide, and Jonn Terje Geitung. "Hospital Admissions from Nursing Homes: Rates and Reasons." Nursing Research and Practice 2011 (2011): 1–6. http://dx.doi.org/10.1155/2011/247623.

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Hospital admissions from nursing homes have not previously been investigated in Norway. During 12 months all hospital admissions (acute and elective) from 32 nursing homes in Bergen were recorded via the Norwegian ambulance register. The principal diagnosis made during the stay, length of stay, and the ward were sourced from the hospital's data register and data were merged. Altogether 1,311 hospital admissions were recorded during the 12 months. Admissions from nursing homes made up 6.1% of the total number of admissions to medical wards, while for surgical wards they made up 3.8%. Infections, fractures, cardiovascular and gastri-related diagnoses represented the most frequent admission diagnoses. Infections accounted for 25.0% of admissions, including 51.0% pneumonias. Of all the admissions, fractures were the cause in 10.2%. Of all fractures, hip fractures represented 71.7. The admission rate increased as the proportion of short-term beds increased, and at nursing homes with short-term beds, admissions increased with increasing physician coverage. Potential reductions in hospitalizations for infections from nursing homes may play a role to reduce pressure on medical departments as may fracture prevention. Solely increasing physician coverage in nursing homes will probably not reduce the number of hospitalizations.

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35

Louis, Daniel, Francesco Taroni, Rita Melotti, Carol Rabinowitz, Maria Vizioli, Monica Fiorini, and Joseph Gonnella. "Increasing appropriateness of hospital admissions in the Emilia-Romagna region of Italy." Journal of Health Services Research & Policy 13, no. 4 (October 2008): 202–8. http://dx.doi.org/10.1258/jhsrp.2008.007157.

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Objectives: The Emilia-Romagna region of Italy has reduced the number of available hospital beds and introduced financial incentives to curb hospital use. The goal of this study was to assess the impact of these policies on changes over time in the number of acute hospital admissions classified in diagnosis related groups (DRGs) that could be treated safely and effectively in alternative, less costly settings. Methods: The assessment of the appropriate site of care was based on analysis of hospital discharge data for all hospitals for the selected diagnosis related groups in the Emilia-Romagna region for 2001 to 2005. The necessity for acute hospital admission was based on the severity of a patient's principal diagnosis, co-morbid diseases and, for surgical admissions, procedure performed. Results: From 2001 to 2005, potentially inappropriate medical admissions of more than one day decreased from 20,076 to 11,580, a 42% decrease. Inappropriate admissions decreased in both public and private hospitals but there remained a higher rate of inappropriate admissions to private hospitals. Potentially inappropriate medical admissions accounted for 128,319 bed-days in 2001 and 68,968 bed-days in 2005, a reduction of 59,351 bed-days. Potentially inappropriate surgical admissions decreased from 7383 in 2001 to 4349 in 2005, a 41% decrease. Bed-days consumed by inappropriate surgical admissions decreased from 23,181 in 2001 to 13,660 in 2005. Conclusions: The Emilia-Romagna region has succeeded in reducing the use of acute hospital beds for patients in selected diagnosis related groups. However, there are still substantial numbers of admissions that could potentially be treated in less costly settings.

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Junarta, Joey, Anita Banerjee, Racquel Lowe-Jones, and Debasish Banerjee. "Management of Acute Admissions of Heart Failure Patients with Kidney Disease." Acute Medicine Journal 18, no. 2 (April 1, 2019): 96–104. http://dx.doi.org/10.52964/amja.0757.

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Acute heart failure (HF) admissions are common. They are often associated with prolonged hospitalisations and poor outcomes. One-third of chronic HF patients also suffer from chronic kidney disease (CKD). Hence, acute admissions of HF with CKD are common and are associated with longer length of stay and increased mortality. Hyperkalaemia and acute on chronic renal impairment are important challenges in the management of these cases. Cautious introduction of high-dose diuretic therapy, followed by the re-commencement of renin-angiotensin-aldosterone (RAAS) inhibitors, improves length of stay, quality of life, and prognosis. During an admission on to the medical assessment unit careful monitoring and management of the patient’s clinical condition and biochemistry is essential.

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Pendlebury, S. T., N. G. Lovett, S. C. Smith, E. Cornish, Z. Mehta, and P. M. Rothwell. "O2.01: Delirium risk stratification in consecutive unselected acute medical admissions." European Geriatric Medicine 5 (September 2014): S54. http://dx.doi.org/10.1016/s1878-7649(14)70107-x.

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Mahmud, Rahel, Adam Gray, Adam Nabeebaccus, and Martin Brunel Whyte. "Incidence and outcomes of long QTc in acute medical admissions." International Journal of Clinical Practice 72, no. 11 (September 17, 2018): e13250. http://dx.doi.org/10.1111/ijcp.13250.

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39

Cameron, AC, SMM Jenkins, and FG Dunn. "The Burden of Atrial Fibrillation in Unselected Acute Medical Admissions." Scottish Medical Journal 53, no. 2 (May 2008): 42–47. http://dx.doi.org/10.1258/rsmsmj.53.2.42.

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40

Hughes, MA, AD Duckworth, I. Edmond, LL Tan, DP Ripley, J. Tucker, and PJ Leslie. "Indiscriminate Coagulation Screening of Acute Medical Admissions: National Cost Ramifications." Scottish Medical Journal 54, no. 4 (November 2009): 32–34. http://dx.doi.org/10.1258/rsmsmj.54.4.32.

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41

Burford, C., A. Cheng, M. Jayne, E. C. Alexander, J. Hall, K. K. Lee, and A. S. Patel. "42THE IMPACT OF DEMENTIA ON MORTALITY IN ACUTE MEDICAL ADMISSIONS." Age and Ageing 47, suppl_3 (August 1, 2018): iii14—iii17. http://dx.doi.org/10.1093/ageing/afy121.07.

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42

Harrison, R., P. Preston, C. Bucur, and SV Fletcher. "P205 Smoking Prevalence and Smoking Cessation Amongst Acute Medical Admissions." Thorax 67, Suppl 2 (November 19, 2012): A153.3—A154. http://dx.doi.org/10.1136/thoraxjnl-2012-202678.266.

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Chotirmall, S. H., S. Picardo, J. Lyons, M. D'Alton, D. O'Riordan, and B. Silke. "Disabling disease codes predict worse outcomes for acute medical admissions." Internal Medicine Journal 44, no. 6 (June 2014): 546–53. http://dx.doi.org/10.1111/imj.12440.

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44

Lien, C. T., A. E. Hill, M. E. T. McMurdo, N. D. Gillespie, R. S. MacWalter, J. M. Watson, W. J. Mutch, and J. L. Hanslip. "Rising Acute Medical Admissions the Potential Role of the Geriatriclan." Age and Ageing 27, suppl 1 (January 1, 1998): P32. http://dx.doi.org/10.1093/ageing/27.suppl_1.p32-a.

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Cunnington, A.-L., G. Mead, S. Faulkner, K. Russell, and M. Ford. "Quality of General Practitioner Referral Letters for Acute Medical Admissions." Age and Ageing 27, suppl 1 (January 1, 1998): P42. http://dx.doi.org/10.1093/ageing/27.suppl_1.p42-c.

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46

Glynn, Nigel, Lisa Owens, Kathleen Bennett, Marie Louise Healy, and Bernard Silke. "Glucose as a risk predictor in acute medical emergency admissions." Diabetes Research and Clinical Practice 103, no. 1 (January 2014): 119–26. http://dx.doi.org/10.1016/j.diabres.2013.10.015.

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Dawson, S. C., Y. Kumarasamy, C. McGoldrick, and R. B. S. Laing. "Antibiotic prescribing practices within a Scottish acute medical admissions unit." Journal of Infection 55, no. 3 (September 2007): e81. http://dx.doi.org/10.1016/j.jinf.2007.04.118.

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48

Manley, Susan E., Kathleen T. O’Brien, Diarmuid Quinlan, Rachel A. Round, Peter G. Nightingale, Fauzi Ali, Behram K. Durrani, et al. "Can HbA1c detect undiagnosed diabetes in acute medical hospital admissions?" Diabetes Research and Clinical Practice 115 (May 2016): 106–14. http://dx.doi.org/10.1016/j.diabres.2016.01.023.

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Fitzpatrick, N. K., C. J. Thompson, H. Hemingway, T. R. E. Barnes, A. Higgitt, C. Molloy, and S. Hargreaves. "Acute mental health admissions in inner London: changes in patient characteristics and clinical admission thresholds between 1988 and 1998." Psychiatric Bulletin 27, no. 1 (January 2003): 7–11. http://dx.doi.org/10.1192/pb.27.1.7.

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Aims and MethodWe undertook a retrospective case-note review of three cohorts of mental health admissions to determine the extent to which patient and service characteristics changed between 1988 and 1998. Changes in clinical admission thresholds were investigated by a psychiatrists' review of handwritten medical admission assessments.ResultsPatients admitted in 1998 were demographically less stable and clinically more complex than those admitted 10 years earlier. Clinical admission thresholds remained consistent.Clinical ImplicationsOur findings suggest that the perceived increase in pressure on psychiatric services over this period was a response to a change in population need. This study highlights important questions about the clinical decision-making process leading to use of alternatives to admission and the appropriateness of acute admissions.

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Blackburn, Anna, Smita Gunda, Berenice Lopez, James Edwards, Nick Spittle, Rob Preston, Richard Baines, et al. "Risk prediction for acute kidney injury in acute medical admissions in the UK." QJM: An International Journal of Medicine 112, no. 3 (November 28, 2018): 197–205. http://dx.doi.org/10.1093/qjmed/hcy277.

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