Rising Emergency Admission and Readmission Rates—a Retrospective Study of Demographic and Socio-economic Factors

Excerpt

Emergency hospital admissions have been rising over time¹; the precise reasons have been debated. A lowered threshold to admit, or changing demographic population structures have been proposed as explanations.² Our institution established an acute medical admission unit in 2002 and its performance in relation to clinical outcomes has been well described.³ We have developed a risk score that is related exponentially to 30-day in-hospital mortality; this estimates acute illness severity and case complexity using both laboratory (multiple-variable fractional polynomial method⁴) and blood culture data supplemented by case complexity estimates calculated from discharge codes (ICD9/ICD10)—Charlson Comorbidity Index and the Chronic Disabling Score. From such determinants, we can assess temporal change in case acuity or complexity, and relate these to admission thresholds.⁵ Our study’s purpose was to examine16 years of acute medical admissions (2002–2017) at St. James’ Hospital, Dublin, to investigate how the incidence rates for emergency medical admissions might have changed over time and to relate such to socio-economic and societal structural changes. …