length of stay

A Risk Index for Geriatric Acute Medical Admissions (RIGAMA)

Research Audit and Clinical Practice, Volume 13, Issue 1, Pages 1 - 52 (2014)

Abstract

Aim: to create and validate a Risk Index for Geriatric Acute Medical Admissions (RIGAMA) for those aged ≥ 65, based on accumulation of deficits.

Methods: we retrospectively validated a 30-item RIGAMA against inpatient mortality, length of stay (LOS), discharge to long-term care (LTC) and 30-day readmission, adjusted for age.

Results: ≥ 1 RIGAMA deficit was superior to age in predicting mortality and prolonged LOS, with a clear incremental effect. The latter was true for ≥3 deficits in predicting 30-day readmission. Three to 5 deficits predicted discharge to LTC better than age.

Conclusion: RIGAMA is easy to collect by the admitting junior doctor and may help trigger early senior support and inform the appropriate use of hospital resources by older patients.

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The Ability of Frailty to Predict Outcomes in Older People Attending an Acute Medical Unit

Research Audit and Clinical Practice, Volume 12, Issue 2, Pages 65 - 124 (2013)

Abstract

Background: This study assessed the role of frailty assessment in the AMU.

Methods: Patients were assessed for frailty and their outcomes ascertained at 90 days.

Results: The Canadian Study on Health and Aging Clinical Frailty Scale categorised 29% of patients as moderately-severely frail. Frailty did not differentially identify those likely to be discharged within one day, nor with long stays. Mortality at 90 days was 32%; frailty was associated with the risk of dying, odds ratio 1.4. 21% of patients were readmitted at 30 days, and 33% at 90 days, but frailty was not predictive.

Discussion: Moderate-severe frailty in people aged 70+ was common and was predictive of higher mortality, but did not appear to predict admission, length of stay or readmission.

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The Payment by Results (PbR) national tariff severely penalises efficiency and early hospital discharge

Original Articles, Volume 8, Issue 3, Pages 95 - 138 (2009)

Abstract

The system of Payment by Results (PbR) was instituted in 2005 to reimburse secondary care for its activity. One of the features of PbR is the short stay tariff (SST), in which only 20-50% of the national tariff is paid if patients have a length of stay (LoS) of less than 2 days in hospital for certain Healthcare Resource Groups (HRGs) – or conditions. We analysed the admissions under Acute Medicine at Bradford Teaching Hospitals over a period of one year and identified the HRGs to which the SST applied. We used the 2007 PbR national tariff to calculate the additional income that would have been generated if these patients were kept in hospital for at least 2 days in order to avoid SST. We calculated an extra theoretical income of approximately £5 million if all these patients had a length of stay (LoS) more than 2 days to avoid the SST. Sixteen additional beds (assuming 85% occupancy) would have been required at a cost of around £1million per year to accommodate these patients. We show that the current PbR system is flawed and penalises hospitals with a higher turnover of patients.

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The admission of older patients to a dedicated short stay medical unit: learning from experience

Original Articles, Volume 6, Issue 3, Pages 93 - 136 (2007)

Abstract

The admission of older patients with acute medical problems to short stay medical units (SSMUs) is controversial in light of their longer expected length of in-patient stay (LoS), coupled with the greater resources required by such a department.

We undertook a prospective study of 120 consecutive SSMU patients aged 60 years or over, to find out whether information gained during the admissions process could predict which candidates would subsequently have a successful SSMU outcome, as well as to assess the overall suitability of the SSMU to older patients.

Our redesigned acute medicine services at Addenbrooker’s Hospital (Cambridge, UK) have taken account of our results, and we continue to admit older patients to our new Medical Short Stay Emergency Unit.

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