Examining the suitability of medical admissions to the emergency short stay ward of a large UK hospital

Introduction

In 1996, a UK audit suggested suboptimal involvement of consultant care in acute medicine [1]. Acute medicine has since evolved as a specialty to improve medical inpatient care in the first 48 hours [2]. Many hospitals now incorporate an acute short stay unit through which up to 70% of medical admissions can be directed [3]. These units reduce the length of hospital inpatient stay [4].

Methods

We conducted a review of case notes for 100 consecutive medical admissions to the Emergency Short Stay ward (ESS). Data collected included diagnoses on admission and discharge, length of stay on ESS and discharge destination. On reviewing each initial medical clerking, an assessment was made regarding the suitability of the admission to ESS, standardized against local criteria.

Results

Data on 100 patients (age 17 to 89) were collected. Eighty-nine per cent were admitted from the medical admissions unit, most commonly for respiratory and cardiac problems. Average length of stay on ESS was 2 days. Twenty-five per cent of patients remained on the ward for over 72 hours and 6% for over 5 days. Whilst 68% of patients were discharged home from ESS, 32% of patients were later transferred to a different ward. When compared with the available admissions criteria, 27% of all admissions to ESS were found to be inappropriate. Most (18/27) of these patients were later transferred to a different inpatient ward. Twenty-six per cent of inappropriate admissions remained on ESS for >48 hours. The total number of medical admissions to the hospital on each day of the study did not affect the number of inappropriate transfers to ESS.

Conclusions

The 24-bed Emergency Short Stay Ward at our UK hospital is for assessment and treatment of selected acute conditions requiring an inpatient stay <48 hours. ESS was not always being used appropriately according to the admission criteria defined by the ward managers. Hospital admissions of >72 hours are associated with significant increase in workload [5]. It is important that a short stay ward does not increase the length of admission by becoming a transit lounge for patients before transfer to a specialty lead ward.