Clin Med
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This aim of this study was to assess the impact of the introduction of a standardised early warning scoring system (SEWS) on physiological observations and patient outcomes in unselected acute admissions at point of entry to care. A sequential clinical audit was performed on 848 patients admitted to a combined medical and surgical assessment unit during two separate 11-day periods. Physiological parameters (respiratory rate, oxygen saturation, temperature, blood pressure, heart rate, and conscious level), in-hospital mortality, length of stay, transfer to critical care and staff satisfaction were documented. ⋯ Following the introduction of the scoring system, inpatient mortality decreased (P=0.046). Staff responding to a questionnaire indicated that the scoring system increased awareness of illness severity (80%) and prompted earlier interventions (60%). A standardised early warning scoring system improves documentation of physiological parameters, correlates with in-hospital mortality, and helps predict length of stay.
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Delirium (acute confusional state) is a common condition in older people, affecting up to 30% of all older patients admitted to hospital. Patients who develop delirium have high mortality, institutionalisation and complication rates, and have longer lengths of stay than non-delirious patients. ⋯ Delirium may be prevented in up to a third of older patients. The aim of this guideline update is to aid prevention as well as the recognition of delirium and to provide guidance on how to manage these complex and disadvantaged patients.
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General hospitals have commonly involved a wide range of medical specialists in the care of unselected medical emergency admissions. In 1999, the Royal Liverpool University Hospital, a 915-bed hospital with a busy emergency service, changed its system of care for medical emergencies to allow early placement of admitted patients under the care of the most appropriate specialist team, with interim care provided by specialist acute physicians on an acute medicine unit - a system we have termed 'specialty triage'. Here we describe a retrospective study in which all 133,509 emergency medical admissions from February 1995 to January 2003 were analysed by time-series analysis with correction for the underlying downward trend from 1995 to 2003. ⋯ No significant effect was seen for those over 65 or all age groups together when corrected for the underlying trend. Length of stay and readmission rates showed a consistent downward trend that was not significantly affected by specialty triage. The data suggest that appropriate specialist management improves outcomes for medical emergencies, particularly amongst younger patients.