Hospital mortality and length of stay differences in emergency medical admissions related to ‘on-call’ specialty

• Published in: Irish journal of medical science Vol. 192; no. 3; pp. 1427 - 1433
• Main Authors: Conway, Richard P., Byrne, Declan G., O’Riordan, Deirdre M. R., Silke, Bernard
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.06.2023
• Subjects: Emergency Service, Hospital; Family Medicine; General Practice; Hospital Mortality; Hospitalization; Humans; Internal Medicine; Length of Stay; Medicine; Medicine & Public Health; Original; Original Article; Retrospective Studies; Admissions; Acute medicine; Speciality; Mortality; Length of stay
• ISSN: 0021-1265; 1863-4362
• DOI: 10.1007/s11845-022-03084-w

Background The outcomes of acute medical admissions have been shown to be influenced by a variety of factors including system, patient, societal, and physician-specific differences. Aim To evaluate the influence of on-call specialty on outcomes in acute medical admissions. Methods All acute medical admissions to our institution from 2015 to 2020 were evaluated. Admissions were grouped based on admitting specialty. Thirty-day in-hospital mortality and length of stay (LOS) were evaluated. Data was analysed using multivariable logistic regression and truncated Poisson regression modelling. Results There were 50,347 admissions in 30,228 patients. The majority of admissions were under Acute Medicine (47.0%), and major medical subspecialties (36.1%); Elderly Care admitted 12.1%. Acute Medicine admissions were older at 72.9 years (IQR 57.0, 82.9) vs. 67.2 years (IQR 50.1, 80.2), had higher Acute Illness Severity (grades 4–6: 85.9% vs. 81.3%; p  < 0.001), Charlson Index (> group 0; 61.5% vs. 54.6%; p  < 0.001), and Comorbidity Score (40.7% vs. 36.7%; p  < 0.001). Over time, there was a small (+ 8%) but significant increase in 30-day in-hospital mortality. Mortality rates for Acute Medicine, major medical specialties, and Elderly Care were not different at 5.1% (95% CI: 4.7, 5.5), 4.7% (95% CI: 4.3, 5.1), and 4.7% (95% CI: 3.9, 5.4), respectively. Elderly Care admissions had shorter LOS (7.8 days (95% CI: 7.6, 8.0)) compared with either Acute Medicine (8.7 days (95% CI: 8.6, 8.8)) or major medical specialties (8.7 days (95% CI: 8.6, 8.9)). Conclusion No difference in mortality and minor differences in LOS were observed. The prior pattern of improved outcomes year on year for emergency medical admissions appears ended.