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Process of care and activity in a clinically inclusive ambulatory emergency care unit : progressive effect over time on clinical outcomes and acute medical admissions

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Reschen, Michael E, Bowen, Jordan, Singh, Sudhir, Rajwani, Mridula, Giles, Matthew, Price, James, Lasserson, Daniel and O'Callaghan, Christopher A (2020) Process of care and activity in a clinically inclusive ambulatory emergency care unit : progressive effect over time on clinical outcomes and acute medical admissions. Future Healthcare Journal, 7 (3). pp. 234-240. doi:10.7861/fhj.2019-0062

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Official URL: http://dx.doi.org/10.7861/fhj.2019-0062

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Abstract

Clinically relevant outcomes for same-day emergency care provided by ambulatory emergency care units (AECs) are largely unknown. We report the activity and outcomes for a large UK adult AEC operating an ambulatory-care-by-default model without specific exclusion criteria.

The AEC consultant triaged all acute medical referrals to either the AEC or the standard non-ambulatory ‘take’ pathway during AEC opening hours.

The proportion of acute medical referrals seen in the AEC increased to 42% (mean 700 referrals seen per month) in the last 6 months of the study and numbers seen in the non-ambulatory pathway fell. The most common diagnoses were for chest pain, pneumonia, cellulitis, heart failure and urinary system disorders. Seventy-four point eight per cent of patients completed their care in a single visit. In the last calendar year, the conversion rate from AEC to inpatient admission was 12%, and the 30-day readmission rate was 6.9% and 18% for the AEC and non-ambulatory pathways, respectively. Across the whole study period, the 30-day mortality was 1.6% and 6.9% for the AEC and non-ambulatory pathway, respectively.

This ambulatory approach is safe and effective.

Item Type: Journal Article
Subjects: R Medicine > RA Public aspects of medicine
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET)
Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Ambulatory medical care , Ambulatory medical care -- Utilization, Hospitals -- Outpatient services
Journal or Publication Title: Future Healthcare Journal
Publisher: Royal College of Physicians
ISSN: 2514-6645
Official Date: 2020
Dates:
DateEvent
2020Published
16 October 2020Available
9 July 2020Accepted
Volume: 7
Number: 3
Page Range: pp. 234-240
DOI: 10.7861/fhj.2019-0062
Status: Peer Reviewed
Publication Status: Published
Publisher Statement: © Clinical Medicine, 2020. The definitive, peer-reviewed and edited version of this article is published in Future Healthcare Journal, 7 (3). pp. 234-240.
Access rights to Published version: Open Access

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