Highlights
- •30-day in-hospital mortality reduced from 12.4% to 4.8% over 16 years.
- •Length of stay and readmission rates remained unchanged.
- •Length of stay was linearly dependent on illness severity and may not be improvable.
Abstract
Background
The Acute Medical Admission Unit (AMAU) model of care has been widely deployed, we
examine changes in hospital readmission rates, length of stay (LOS) and 30-day in-hospital
mortality over 16 years.
Methods
All emergency medical admissions between 2002 and 2017 were examined. We assessed
30-day in-hospital mortality, readmission rates, and LOS using logistic regression
and margins statistics modelled outcomes against predictor variables.
Results
There were 106,586 admissions in 54,928 patients over 16 years. Calculated per patient
the 30-day in-hospital mortality was 8.9% (95%CI 8.6% to 9.2%) and showed a relative
risk reduction (RRR) of 61.1% from 12.4% to 4.8% over the 16 years (p = .001). Calculated
per admission the 30-day in-hospital mortality was 4.5% (95%CI 4.4% to 4.6%) with
a RRR of 31.9% from 2002 to 2017. Over this extended period 48.7% of patients were
readmitted at least once, 9.3% >5 times and 20 patients >50 times each. The median
LOS was 5.9 days (IQR 2.4, 12.9) with no trend of change over time. Total readmissions
increased as a time dependent function; early readmissions (<4 weeks) fluctuated without
time trend at 10.5% (95%CI 9.6 to 11.3). A logistic regression model described the
hospital LOS as a linear function both of comorbidity and the utilisation of inpatient
procedures and services.
Conclusion
30-day in-hospital mortality showed a linear trend to reduce over time at unaltered
LOS and readmission rates. LOS showed linear dependency on clinical complexity; interventions
aimed at reducing LOS may not be appropriate beyond a certain point.
Keywords
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Article info
Publication history
Published online: June 10, 2019
Accepted:
June 4,
2019
Received in revised form:
June 1,
2019
Received:
April 15,
2019
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
