trends in emergency admission and discharge
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Trends in emergency admission and discharge. Steve Kendrick ISD Scotland www.isdscotland.org/wholesystem Nursing Strategy Programme Discharge Developments across North Glasgow August 17 th , 2005. Stobhill Hospital. Why the increase?. - PowerPoint PPT PresentationTRANSCRIPT
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Trends in emergency admission and discharge
Steve KendrickSteve Kendrick ISD ScotlandISD Scotland
www.isdscotland.org/wholesystemwww.isdscotland.org/wholesystem
Nursing Strategy ProgrammeNursing Strategy ProgrammeDischarge Developments across North GlasgowDischarge Developments across North Glasgow
August 17August 17thth, 2005. Stobhill Hospital, 2005. Stobhill Hospital
2
Scotland's older population by 5 year age group. Trends (1911 to 2002) and GAD projections (2003 to 2042)
(data from 2028 is linear interpolation between selected years: 2031, 2036,2041)
0
50000
100000
150000
200000
250000
300000
350000
400000
1911 1921 1931 1941 1951 1961 1971 1981 1991 2001 2011 2021 2031 2041
Year
Po
pu
lati
on
85 and over
80 to 84
75 to 79
65 to 69
70 to 75
2004
3
Trends (1981-2002) in emergency admission rates by age group.
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
5000019
81
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
Admission year
Em
erge
ncy
adm
issi
ons
per
100,
000
pop
0-405-0910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+
4
Numbers of emergency admissions by age group. 1981-2002.
0
5000
10000
15000
20000
25000
30000
35000
40000
4500019
81
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
Admission year
Em
erg
ency
ad
mis
sio
ns
0-4
05-0910-14
15-1920-24
25-2930-34
35-3940-44
45-49
50-5455-59
60-6465-69
70-7475-79
80-8485+
5
Emergency inpatient admissions by diagnosis group. Ages 80 and over. Scotland. 1981 to 2002.
0
2000
4000
6000
8000
10000
12000
14000
16000
Adm
issi
ons
Cancer
Heart
Circulatory
Respiratory
Digestive
Mental
Symptoms
Injuries
Other
6
Length of stay after emergency admission by age group.Scotland. 1981 to 2002.
0
5
10
15
20
25
30
35
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
Admission year
Leng
th o
f sta
y
0-405-0910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485+
7
Bed days used by emergency inpatients by broad age group. 1981 to 2002.
45 to 64
65 to 79
0
500000
1000000
1500000
2000000
2500000
3000000
3500000
4000000
4500000
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
Admission year
Bed
day
s pe
r an
num 80 and over
Under 45
8
Patients with 3 or more emergency admissions within 1 year by age group. Per 100,000 population. Scotland 1981 to 2002.
0
500
1000
1500
2000
2500
300019
81
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
Admission year
Pa
tien
ts p
er
10
0,0
00
po
pu
latio
n
0-4
05-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85 & over
Age group
9
Number of patients with 3 or more emergency admissions within 1 year. By age group. 1981 to 2002.
0
500
1000
1500
2000
2500
300019
81
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
Admission year
Nu
mb
er o
f p
atie
nts
0-4
05-910-14
15-1920-24
25-29
30-3435-39
40-4445-49
50-5455-59
60-64
65-6970-74
75-7980-84
85 & over
10
Bed days occupied by patients with one, two and three or more emergency admissions in a 1 year period. Patients aged 80 and over 1981 to 2002
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,00019
81
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
Admission year
Bed
day
s
Three or more
Tw o
One
11
Why the increase?
• Population change – more of oldest old: some effect Population change – more of oldest old: some effect (20%) – likely to become more powerful driver(20%) – likely to become more powerful driver
• Population not getting sicker – but more frail elderly Population not getting sicker – but more frail elderly at home – and living alone.at home – and living alone.
• Patterns of social change – some effectPatterns of social change – some effect
• Main driver has been the structure of the care system Main driver has been the structure of the care system – lack of preventative, continuous care – emergency – lack of preventative, continuous care – emergency admission as default.admission as default.
12
0
2
4
6
8
10
12
14
16
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Year
Pe
rce
nt
7 and 28 day emergency readmission rates.Medical inpatients.
Stobhill and Scotland 1991 to 2000.
13
0
2
4
6
8
10
12
14
16
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Year
Perc
en
t
7 and 28 day emergency readmission rates.Surgical inpatients.
Stobhill and Scotland 1991 to 2000.
14
0
2
4
6
8
10
12
14
16
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Year
Perc
en
t
7 and 28 day emergency readmission rates.Surgical day cases.
Stobhill and Scotland 1991 to 2000.
15
Predicting likelihood of future emergency admissions (2001) on basis of age, diagnosis and previous history of emergency admissions (1996 – 2000)
1996 1997 1998 1999 2000 2001
Age at end 2000
16
Per cent of population admitted as emergency in 2001 by age and number of admissions 1996 - 2000. Scotland
0
10
20
30
40
50
60
65-69 70-74 75-79 80-84 85+
Age group
Per
cen
tNone
One
Two
Three
Four ormore
Number of emergency admissions 1996-2000
17
Patients aged 80 and over. Probability of being admitted as an emergency in 2002. By number of emergency admissions 1997-2001 and most recent admissions
diagnosis.
0
10
20
30
40
50
60
Broad diagnosis group.
Pro
bab
ilit
y o
f ad
mis
sio
n i
n 2
002.
One
Two
Three
Four or more
Emergency admissions. 1997-2001.
18
Delayed discharge by type of admission.Scotland 2001.
Type of admission. Admissions Number Percentage Percentage ofdelayed delayed all delays
Elective 100494 231 0.23 4.1%
Transfer 2249 141 6.27 2.5%
Emergency 113502 4763 4.20 84.0%
Psychiatric 3128 532 17.01 9.4%
Total 219373 5667 2.58 100.0%
19
Delayed discharge by reason: delays of six weeks and over.September 2000 to April 2005. Scotland.
0
500
1000
1500
2000
2500
Sep2000
Jan2001
Apr2001
July2001
Oct2001
Jan2002
Apr2002
July2002
Oct2002
Jan2003
Apr2003
July2003
Oct2003
Jan2004
Apr2004
July2004
Oct2004
Jan2005
Apr2005
Census
Num
ber
of p
atie
nts
Other
Legal/Financial
Patient exercising statutoryright of choice
HealthcareAssessment/Arrangements
Aw aiting place availabilityin a care home
Aw aiting funding for a carehome placement
Patients w aiting to go home
Community CareAssessment reasons
20
Delayed discharge by reason: delays of six weeks and over.September 2000 to April 2005. Glasgow City.
0
50
100
150
200
250
Sep2000
Jan2001
Apr2001
July2001
Oct2001
Jan2002
Apr2002
July2002
Oct2002
Jan2003
Apr2003
July2003
Oct2003
Jan2004
Apr2004
July2004
Oct2004
Jan2005
Apr2005
Census
Num
ber
of p
atie
nts
Other
Legal/Financial
Patient exercising statutoryright of choice
HealthcareAssessment/Arrangements
Aw aiting place availabilityin a care home
Aw aiting funding for a carehome placement
Patients w aiting to go home
Community CareAssessment reasons
21
Delayed discharge by reason: delays of under six weeks.September 2000 to April 2005. Scotland .
0
200
400
600
800
1000
1200
Sep2000
Jan2001
Apr2001
July2001
Oct2001
Jan2002
Apr2002
July2002
Oct2002
Jan2003
Apr2003
July2003
Oct2003
Jan2004
Apr2004
July2004
Oct2004
Jan2005
Apr2005
Census
Num
ber
of p
atie
nts
Other
Legal/Financial
Patient exercising statutoryright of choice
HealthcareAssessment/Arrangements
Aw aiting place availabilityin a care home
Aw aiting funding for a carehome placement
Patients w aiting to go home
Community CareAssessment reasons
22
Delayed discharge by reason: delays of under six weeks.September 2000 to April 2005. Glasgow City.
0
20
40
60
80
100
120
140
160
Sep2000
Jan2001
Apr2001
July2001
Oct2001
Jan2002
Apr2002
July2002
Oct2002
Jan2003
Apr2003
July2003
Oct2003
Jan2004
Apr2004
July2004
Oct2004
Jan2005
Apr2005
Census
Nu
mb
er o
f p
atie
nts
Other
Legal/Financial
Patient exercising statutoryright of choice
HealthcareAssessment/Arrangements
Aw aiting place availabilityin a care home
Aw aiting funding for a carehome placement
Patients w aiting to go home
Community CareAssessment reasons
23
Admissions (2001) linked to Delayed Discharge Censuses andadmissions in previous five years
1996 1997 1998 1999 2000 2001
Age, diagnosisetc.on admission
24
Per cent experiencing delayed discharge after emergency or psychiatric inpatient admission by age
category and gender in Scotland 2001
0%
2%
4%
6%
8%
10%
12%
65-69 70-74 75-79 80-84 85-89 90+
Age category
Per
cen
t d
ela
yed
Male
Female
25
Per cent delayed discharge following emergency or psychiatric inpatient admission. By broad diagnosis category. Scotland. 2001 and 2002.
0%
2%
4%
6%
8%
10%
12%
14%
16%
1. Can
cer
2. Hea
rt di
seas
e
3. Oth
er ci
rcul
ator
y
4. Res
pira
tory
5. Dig
estiv
e/urin
ary
6. Men
tal/n
ervo
us sy
stem
7. Sig
ns, s
ympt
oms e
tc.
8. In
jurie
s
9. Oth
er
Diagnosis category
Per
cen
t d
elay
ed
2001 2002
26
Per cent delayed discharge following emergency or psychiatric inpatient admission by diagnosis group and
age category in Scotland 2001
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
Diagnosis category
Per
cen
t d
ela
yed
65-69
70-74
75-79
80-84
85-89
90+
27
Per cent delayed discharge following emergency or psychiatric inpatient admission by age category and
previous emergency admissions in Scotland 2001
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
65-69 70-74 75-79 80-84 85-89 90+
Age category
Per
cen
t d
ela
yed
none
1
2 or 3
4 or more
Previous emergency admissions
28
Probability of delayed discharge after psychiatric or emergencyinpatient admission: the main high probability diagnosesScotland 2001.
ICD10 codes Diagnosis Admitted Delayed Per cent delayed
F01, F03, G30
Dementia, Alzheimer's 2270 621 27.4%
I60 to I69 Stroke 6386 714 11.2%
R26 Difficulty walking etc. 1705 299 17.5%
R41
Confusion, disorientation 997 168 16.9%
R54 Senility 927 172 18.6%
S72 Hip fracture 4375 438 10.0%
29
Per cent delayed discharge following emergency or psychiatric inpatient admission by age category and
mental/nervous system disorders diagnosis in Scotland 2001
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
65-69 70-74 75-79 80-84 85-89 90+
Age category
Pe
r c
en
t d
ela
ye
d
mental/nervous system disorders main
mental/nervous system disorders secondary
no mental/nervous system disorders