Admission of asthma patients after treatment at an

Admission of asthma patients after treatment at an Emergency Department Treatment Centre (EDTC) in Singapore LATHY PRABHAKARAN 1, CHAN S P 2, JANE C 1, ABISHEGANANDED J 3, LIM G H 4 TAN W L 4 Department of Nursing 1, Clinical Research Unit 2 Respiratory Medicine 3, Emergency Medicine 4 Tan Tock Seng Hospital, Singapore

Background n Our hospital experienced a severe problem of overcrowding of patients awaiting hospital admission at Emergency Department. n The management looked for other alternative to hospitalize patients with certain acute medical condition. n Decided to explore Emergency short-stay units.

Literature Review n Emergency short stay units have been present in the ED worldwide for several decades. n Shown to reduce length of stay 1 -4, improve ED efficiency 5, be cost effective 6 and reduce the number of inpatient admissions 7.

Proposed 24 hours Emergency Department Treatment Centre (EDTC). n Open 15 th September 2005. n 22 beded unit. n Own medical and nursing staffs from ED. n Admit 13 different types of medical conditions. n Use care paths to guide treatment and management. n

Proposed One of the common condition seen at ED is asthma. n Thus this study looked at decreasing hospitalization rate for asthma by admitting asthmatic who did not respond to initial therapy at ED to EDTC n

Aim Of Study To identify factors associated with admission to hospital after treatment at EDTC for acute asthma. n Length of stay. n Compared cost. n

Asthma cases seen at ED in 2006 Flow Chart 1: This study looks at EDTC admission

Criteria to admit to EDTC n Inclusion Criteria n n n Not responding to initial therapy at ED Stable vital signs ED re-attenders within 72 hrs n Exclusion Criteria n n Severe asthma History of intubation/ICU care Significant co-morbidities Social circumstances

Management of asthma at EDTC n Medical Management n As stated in asthma pathway n Role of asthma nurse n As stated in Patient Family Education

Criteria for discharge and transfer to inpatient ward n For discharge n n Relief of symptoms Patients understands treatment needs n For transfer to inpatient ward n n Deterioration in condition Develop any other acute medical condition requiring inpatient management

Methodology Analysis of computer database records of all asthma patients that were admitted to EDTC over a period of Jan – Dec 2006. n n Data analyzed included demographic characteristics such as age, sex, ethnicity and ED attendance prior and post 40 days and 24 hrs for acute asthma.

Statistical Analysis Software: Stata 10. 1 n Method: Multiple logistic regression n All tests conducted at 5% level of significance n

Outcome of asthma cases admitted to EDTC Flow Chart 2:

Results Table 1: Demographic Characteristics Variables Patients Discharged Patients transferred to inpatient ward Total 181 67 Male 80 (76. 9%) 24 (23. 1%) Female 101(70. 1%) 43 (29. 9%) Chinese 65 (77. 38%) 19 (22. 6%) Malay 58 (69. 9%) 25 (30. 1%) Indian 44 (66. 7%) 22 (33. 3%) Others 14 (93. 3%0 1 (6. 67%) < 20 years old 27 (90%) 3 (10%) 21 -30 35 (70%) 15 (30%) 31 -40 31 (67. 4%) 15 (32. 6%) 41 -50 41 (70. 1%) 17 (29. 3%) 51 -60 30 (79%) 8 (21%) 61 -70 7 (50%) 71 -80 9 (81. 8%) 2 (18. 2%) >81 1 (100%) 0 Sex Race Age

Results Table 2: Factors associated with admission to hospital after treatment at EDTC * Factor Adjusted Odds Ratio (95% C. I. ) P value ED attendance (40 days prior) 1. 72 (0. 82 -3. 59) 0. 15 ED attendance (24 -hr prior) 1. 54 (0. 54 -4. 41) 0. 42 * Multiple logistic regression analysis adjusted for demographics (age, gender and ethnicity) v. None of the considered factors (demographics and prior ED attendance was significantly associated with admission

Results Flow Chart 3: n 3% of patients were readmitted post 40 days of discharged. n. This readmission rate was non-significantly lower than that of discharged patients (5. 5%; p: 0. 41).

Results n Comparison of Length of Stay • Patients Discharged VS Transferred to ward 1 : 3. 4 n safe discharge of 73% of patients. n No of beds saved = 181(discharged)

Results n Comparison of Cost • Patients Discharged Vs Transferred to ward Mean: $151. 2 Vs $ 682. 1 Low to High range: $58. 7 -$626. 6 Vs $173 -$2783

Conclusion n Demographic and previous ED visits were not significantly associated with admission to hospital. The older patients were found to be staying longer than younger patients (p: 0. 01). Treatment at EDTC resulted in n n safe discharge of 73% of patients. saved 181 beds. 3% of patients were readmitted post 40 days of discharged. This readmission rate was non-significantly lower than that of discharged patients (5. 5%; p: 0. 41).

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