Hong Kong Journal of Emergency Medicine

Volume 9 Number 3, July 2002

A retrospective study of patients discharged within 24 hours after emergency admission in a public general hospital

SST Cheng and CH Chung

Objectives: To identify the epidemiological characteristics and outcome of patients who were discharged within 24 hours of emergency admission, and to explore methods to reduce inappropriate admission. Design: Retrospective study. Setting: Emergency admission in a public general hospital in Hong Kong. Patients: Four hundred and ninety-one cases collected in a three-month period from 1st April 2000 to 30th June 2000, excluding those who died within 24 hours of admission. Main outcome measures: Patients' epidemiological and clinical characteristics, specialty of admission, in-patient procedures performed, diagnosis upon discharge and destination of patients. Results: During the study period, 8.8% of the 5,587 emergency admissions were discharged within 24 hours. Most of them were middle-aged males, triaged as category 3 and 4 non-trauma cases. The percentage of emergency Orthopaedic and Surgical admission resulting in discharge within 24 hours was 18.5% and 16.2% respectively, substantially higher than the percentage of emergency Medical and Paediatric admission (5.5% and 4.7% respectively). The most common diagnoses included orthopaedic open soft tissue injuries, orthopaedic closed fractures and dislocations, head injury, drug overdose, abdominal pain, ischaemic heart disease or chest pain and foreign body in throat. Overall, 20.8% of cases received some forms of orthopaedic procedures, 9% had computed tomography (CT) brain done, and 5.5% had OGD performed. Around 90% of cases with orthopaedic open soft tissue injuries and closed fractures or dislocations received intervention, 73% of head injury cases had CT brain done, and around 63% of patients with foreign body in throat received oesophago-gastro-duodenoscopy (OGD). Overall, 14% of cases discharged themselves against medical advice or walked away after admission. Up to 9.8% were transferred to other hospitals within 24 hours. Around 54.8% were followed up in hospital after discharge, and re-admission was planned in 2.9% for elective procedures. Only 13 cases (2.6%) were re-admitted through A&E within one week with the same diagnosis into the same specialty. Conclusions: The issue of 'discharge within 24 hours' should not automatically be regarded as inappropriate emergency admission. Upgrade of professional training and clinical supervision, improvement of administrative arrangement and clinical audit are possible measures to enhance the efficiency of hospital utilization. (Hong Kong j.emerg.med. 2002;9:139-144)

Keywords : Emergency service, hospital, hospitalization, length of stay, patient admission, patient discharge

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