384 What Proportion of Pyelonephritis Admissions Under Urology Care Have Surgical Pathology

Aim To identify the proportion of pyelonephritis patients admitted with true urological pathology Method Retrospective audit Results The majority of adults admitted with diagnosis of pyelonephritis (80%) remain under urology team from 1st day of admission Of the 80% only 9% had an underlying urological pathology confirmed by imaging AND requiring invasive intervention Conclusions High rate of inappropriate admission to surgical / urological ward with subsequent pressure on beds and inevitable cancellations on some occasions Acute pyelonephritis should not be routinely admitted under urology unless there is clear evidence of underlying obstructing pathology or no obvious improvement on antibiotics Consider imaging in terms of US/CT KUB in first instance before making any referral to urology

Distribution of the Indicator of the Appropriate Admission of Patients with Circulatory System Diseases to County Hospitals in Rural China: A Cross-Sectional Study

Background: The inappropriate admission of patients with circulatory system diseases (CSDs) have contributed to the rapid increase in hospitalisation rates in China. The purpose of this study is to identify the key indicators of appropriate admission and their distribution by analysing CSD cases. Methods: A total of 794 records of inpatient CSD cases were collected from county hospitals in five counties in midwestern rural China through stratified random sampling and evaluated by using the Rural Appropriateness Evaluation Protocol (RAEP). RAEP has two parts: Indicator A, which represents requirement for services, and Indicator B, which represents diseases severity. Indicator distribution was analysed through frequency analysis. A three-level logistic regression model was used to examine the sociodemographic determinants of the positive indicators of appropriate CDSs admissions. Result: The inappropriate admission rate of CSDs was 33.4% and varied between counties. A2 (Varying dosage/drug under supervision, 58.22%), A8 (Stopping/continuing oxygen inhalation, 38.19%), A7 (Electrocardiogram per 2 hours, 34.22%), A3 (Calculation of intake and output volume, 31.19%) and B14 (Abnormal blood condition, 27.98%) were the top five positive indicators of CSDs. Indicator A (requirements for services) was more active than Indicator B (disease severity). The limitation of the role of Indicator B over time may be attributed to the different policies and environments of rural China and stimulated the increase in inappropriate admission rates. The results of three-level logistic regression suggested that the influence of gender, year, region and disease type on positive indicators should receive increased attention in the evaluation of CSDs admissions. Conclusion: This study found that A2, A8, A7, A3 and B14 were the key indicators and were helpful to determine the appropriate admission of CSDs in rural China. Managers may focus on these indicators, particularly the use of indicator A.

Determinants of inappropriate admission of elderly people in county-level hospitals: a cross-sectional study in rural China

ObjectiveThe purpose of this paper is to investigate the characteristics and determinants of inappropriate admission to hospital of elderly people in rural China.DesignA cross-sectional study of a comparison between the elderly and non-elderly groups of people.SettingThe survey was conducted on the largest county-level general hospitals in four counties in central and western China.ParticipantsA total of 652 rural patients admitted in hospitals were surveyed, who were divided into two groups according to age: elderly group (n=230, age ≥60 years) and non-elderly group (n=422, age <60 years).Primary measuresThe Chinese version of the appropriateness evaluation protocol was used to evaluate the inappropriate admission rates. The interactive regression models based on the relationship of age (elderly and non-elderly) with other factors and binary logistic regression models were used in the analysis of the specific factors and determinants of the inappropriate admission of elderly people.ResultThe inappropriate admission rate for the rural elderly was 30%, which was lower than that of the non-elderly people (40.8%). Compared with the non-elderly group, women in the elderly group (OR=0.33, 95% CI 0.15 to 0.73) had a lower incidence of inappropriate admission, and elderly people with chronic diseases (OR=3.33, 95% CI 1.23 to 9.04) were more prone to being inappropriately admitted than non-elderly people with chronic diseases. The binary logistic regression analysis shows that county, age (OR=0.94. 95% CI 0.90 to 0.99), gender (OR=0.49, 95% CI 0.25 to 2.98), department and response to doctor’s admission request were the determinants of the inappropriate admission of elderly patients.ConclusionThe inappropriate admission rate of elderly people in rural China was high. We found that gender and chronic disease are the specific factors that were specific to non-elderly people. County, age, gender, department and response to a doctor’s admission request had substantial influence on the inappropriate admission of the elderly in rural China.

Interviewing older people about their experiences of emergency hospital admission: methodology in health services research

This essay makes the case for increased use of patient-centred methodologies, which involve patients and the public, in the area of emergency admissions research in the United Kingdom. Emergency admission research has rarely made use of the patient voice when attempting to find a rate of ‘inappropriate’ admission for older people, instead focusing on professional viewpoints and more abstract tools. We argue for the important insights that patients and their families bring to emergency admissions research and for the need to listen to and use these voices to find more holistic responses to the issue of unplanned admissions to hospital for those aged over 65. This area of health services research is highly complex, but without involving the patient viewpoint we risk not understanding the full story of events leading up to admission and what preventative measures might have helped, and therefore we also risk developing less effective, simplistic solutions. In the face of increasing challenges to the National Health Service’s ability to provide safe, effective and affordable care for older people, researchers need to listen to those with direct and longitudinal experience of their ill health and admission.

Preventative Healthcare

Australia’s ageing population has escalated the demand for current health services and the trend could compound to unsustainable levels under the current health system. This chapter proposes a preventative healthcare model based on assistive technology to strengthen wellbeing at the individual and community level. The proposed model could minimise premature and inappropriate admission of Australians to care facilities while enhancing their independence and self care. It could also present a cost effective approach for policy makers by helping to alleviate the escalating costs of the health system. Importantly, this program offers an effective and sustainable alternative for delivering future health services.