Trends in emergency admission and discharge

1

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.


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.


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







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







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







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

Trends in emergency admission and discharge

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