Measuring 'True Admission Avoidance' in Ambulatory care
Authors: Ellis, S., Heffernan, C., Lad, T. and Nadarajah, C.
Conference: Society of Acute Medicine: Amsterdam
Abstract:AIMs: Ambulatory Emergency Clinic (AEC) is a recent addition to Basingstoke and North Hampshire Hospital. In January 2017 additional acute medical consultants were appointed to help develop the service. The clinic is consultant lead and operates Monday-Friday 09:00-18:00. AEC accepts referrals directly from GP's and operates a push/pull system for ED. Out of hours referrals can be made via the medical registrar on-call. Before expanding the service we studied the true impact of AEC by not only looking at patients diverted from the medical take but also 30-day readmission and mortality rates thereby reflecting 'true' admissions avoidance.
METHODS: Data was collected prospectively from January to June 2017. We measured the number of patients diverted from the medical take to AEC and the number of patients who subsequently required readmission. Patients were followed up at 30 days to measure readmission rates and mortality rate. True admission avoidance (TAA) was calculated using the following formula: TAA (%) =((New AEC patients + follow up AEC patients) - (same day admission + 30 day AEC readmission)) / total medical admission x 100
RESULTS: Over six months 20.3% of patients were diverted from the medical take to AEC. Of those seen by AEC, 10.7% required hospital admission. The 30 day readmission rate was 2% and the true admission avoidance was 24.7%.
CONCLUSION: AEC diverts a significant proportion of the medical take. To study the true impact of AEC; 30 day readmission rates, true admission avoidance and mortality rates should also be measured. Our data suggests AEC can deliver significant true admission avoidance whilst maintaining low readmission and mortality rates. Our service is due to expand further in 2018 and this data provides supporting evidence both in terms of clinical effectiveness and patient safety
Source: Manual