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      Hospitalisation in an emergency department short-stay unit compared to an internal medicine department is associated with fewer complications in older patients – an observational study

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          Abstract

          Background

          Older patients are at particular risk of experiencing adverse events during hospitalisation.

          Objective

          To compare the frequencies and types of adverse events during hospitalisation in older persons acutely admitted to either an Emergency Department Short-stay Unit (SSU) or an Internal Medicine Department (IMD).

          Methods

          Observational study evaluating adverse events during hospitalisation in non-emergent, age-matched, internal medicine patients ≥75 years, acutely admitted to either the SSU or the IMD at Holbaek Hospital, Denmark, from January to August, 2014. Medical records were reviewed by independent assessors to detect adverse events according to predefined criteria. The primary outcome was the proportion of patients with an adverse event during and within 30 days after hospitalisation. Secondary outcomes included 90-day mortality, subtypes of adverse events, and timing of adverse events. Adjusted analyses were conducted to correct for potential confounders.

          Results

          Four-hundred-fifty patients, 225 patients in each group, were included. Adverse events were found in 67 (30%) patients in the SSU-group and 90 (40%) patients in the IMD group (Odds Ratio (OR) 0.64 (95% Confidence Interval (95% CI) 0.43–0.94, p = 0.02). The result was unchanged in an analysis adjusted for age, Charlson Comorbidity score, and sex. We found no significant difference in 90-day mortality (OR 0.75, 95% CI 0.41–1.38, p = 0.36). The most common adverse events were transfer during hospitalisation, unplanned readmission, and nosocomial infection.

          Conclusions

          Adverse events of hospitalisation were significantly less common in older patients acutely admitted to an Emergency Department Short-stay Unit as compared to admission to an Internal Medicine Department.

          Related collections

          Most cited references 21

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          The Quality in Australian Health Care Study.

          A review of the medical records of over 14,000 admissions to 28 hospitals in New South Wales and South Australia revealed that 16.6% of these admissions were associated with an "adverse event", which resulted in disability or a longer hospital stay for the patient and was caused by health care management; 51% of the adverse events were considered preventable. In 77.1% the disability had resolved within 12 months, but in 13.7% the disability was permanent and in 4.9% the patient died.
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            Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions.

            We sought to synthesize the literature on patterns of use of emergency services among older adults, risk factors associated with adverse health outcomes, and effectiveness of intervention strategies targeting this population. Relevant articles were identified by means of an English-language search of MEDLINE, HealthSTAR, CINAHL, Current Contents, and Cochrane Library databases from January 1985 to January 2001. This search was supplemented with literature from reference sections of the retrieved publications. A qualitative approach was used to synthesize the literature. Compared with younger persons, older adults use emergency services at a higher rate, their visits have a greater level of urgency, they have longer stays in the emergency department, they are more likely to be admitted or to have repeat ED visits, and they experience higher rates of adverse health outcomes after discharge. The risk factors commonly associated with the negative outcomes are age, functional impairment, recent hospitalization or ED use, living alone, and lack of social support. Comprehensive geriatric screening and coordinated discharge planning initiatives designed to improve clinical outcomes in older emergency patients have provided inconclusive results. Older ED patients have distinct patterns of service use and care needs. The current disease-oriented and episodic models of emergency care do not adequately respond to the complex care needs of frail older patients. More research is needed to determine the effectiveness of screening and intervention strategies targeting at-risk older ED patients.
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              Incidence and types of adverse events and negligent care in Utah and Colorado.

              The ongoing debate on the incidence and types of iatrogenic injuries in American hospitals has been informed primarily by the Harvard Medical Practice Study, which analyzed hospitalizations in New York in 1984. The generalizability of these findings is unknown and has been questioned by other studies. We used methods similar to the Harvard Medical Practice Study to estimate the incidence and types of adverse events and negligent adverse events in Utah and Colorado in 1992. We selected a representative sample of hospitals from Utah and Colorado and then randomly sampled 15,000 nonpsychiatric 1992 discharges. Each record was screened by a trained nurse-reviewer for 1 of 18 criteria associated with adverse events. If > or =1 criteria were present, the record was reviewed by a trained physician to determine whether an adverse event or negligent adverse event occurred and to classify the type of adverse event. The measures were adverse events and negligent adverse events. Adverse events occurred in 2.9+/-0.2% (mean+/-SD) of hospitalizations in each state. In Utah, 32.6+/-4% of adverse events were due to negligence; in Colorado, 27.4+/-2.4%. Death occurred in 6.6+/-1.2% of adverse events and 8.8+/-2.5% of negligent adverse events. Operative adverse events comprised 44.9% of all adverse events; 16.9% were negligent, and 16.6% resulted in permanent disability. Adverse drug events were the leading cause of nonoperative adverse events (19.3% of all adverse events; 35.1% were negligent, and 9.7% caused permanent disability). Most adverse events were attributed to surgeons (46.1%, 22.3% negligent) and internists (23.2%, 44.9% negligent). The incidence and types of adverse events in Utah and Colorado in 1992 were similar to those in New York State in 1984. Iatrogenic injury continues to be a significant public health problem. Improving systems of surgical care and drug delivery could substantially reduce the burden of iatrogenic injury.
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                Author and article information

                Contributors
                +45 26793500 , cstr@regionsjaelland.dk
                talakhadem@gmail.com
                laurits.s.hansen@gmail.com
                lars.simon.rasmussen.01@regionh.dk
                tasm@regionsjaelland.dk
                Journal
                Scand J Trauma Resusc Emerg Med
                Scand J Trauma Resusc Emerg Med
                Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
                BioMed Central (London )
                1757-7241
                15 August 2017
                15 August 2017
                2017
                : 25
                Affiliations
                [1 ]ISNI 0000 0001 0674 042X, GRID grid.5254.6, Department of Emergency Medicine, Holbaek Hospital, , University of Copenhagen, ; Holbaek, Denmark
                [2 ]ISNI 0000 0001 0674 042X, GRID grid.5254.6, Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, , University of Copenhagen, ; Copenhagen, Denmark
                [3 ]ISNI 0000 0001 0674 042X, GRID grid.5254.6, Institute of Clinical Medicine, Faculty of Health and Medical Sciences, , University of Copenhagen, ; Copenhagen, Denmark
                [4 ]ISNI 0000 0004 0646 8763, GRID grid.414289.2, Department of Anaesthesiology, , Holbaek Hospital, University of Copenhagen, ; Holbaek, Denmark
                Article
                422
                10.1186/s13049-017-0422-9
                5558657
                28810888
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funding
                Funded by: Region Zealand Research Foundation and Copenhagen University
                Award ID: 13-53
                Award Recipient :
                Funded by: Region Zealand Research Foundation
                Award ID: 12-000095
                Award Recipient :
                Categories
                Original Research
                Custom metadata
                © The Author(s) 2017

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