Data from: Risk factors for admission at three urban emergency departments in England: a cross-sectional analysis of attendances over 1 month

Objective: to investigate factors associated with unscheduled admission following presentation to Emergency Departments (EDs) at three hospitals in England. Design and setting: cross-sectional analysis of attendance data for patients from three urban EDs in England: a large teaching hospital and major trauma centre (Site 1), and two district general hospitals (Sites 2 and 3). Variables included: patient age, gender, ethnicity, deprivation score, arrival date and time, arrival by ambulance or otherwise, a variety of ED workload measures, inpatient bed occupancy rates and admission outcome. Coding inconsistencies in routine ED data used for this study meant that diagnosis could not be included. Outcome measure: The primary outcome for the study was unscheduled admission. Participants: all adults aged 16 and over attending the three inner London EDs in December 2013. Data on 19,734 unique patient attendances were gathered. Results: outcome data were available for 19,721 attendances (>99%), of whom 6,263 (32%) were admitted to hospital. Site 1 was set as the baseline site for analysis of admission risk. Risk of admission was significantly greater at Sites 2 and 3 (AOR relative to Site 1 for Site 2 was 1.89, 95% CI 1.74-2.05, p<0.001), and for patients of black or black British ethnicity (1.29, 1.16-1.44, p<0.001). Deprivation was strongly associated with admission. Analysis of departmental and hospital-wide workload pressures gave conflicting results, but proximity to the “four-hour target” (a rule that limits patient stays in EDs to four hours in the NHS in England) emerged as a strong driver for admission in this analysis (3.61, 3.30-3.95, p<0.001). Conclusion: this study found statistically significant variations in odds of admission between hospital sites when adjusting for various patient demographic and presentation factors, suggesting important variations in ED- and clinician-level behaviour relating to admission decisions. The four-hour target is a strong driver for emergency admission.

研究目的：探究英国三家医院急诊科（Emergency Departments, EDs）就诊后非计划住院的相关影响因素。
研究设计与研究场景：针对英国三家城市急诊科的就诊数据开展横断面分析，三家急诊科分别为：一家大型教学医院兼创伤中心（站点1），以及两家地区综合医院（站点2与站点3）。
纳入变量：包括患者年龄、性别、种族、贫困得分、就诊日期与时间、是否由救护车转运、多项急诊科工作量指标、住院床位占用率及住院结局。
数据局限：本研究所使用的常规急诊科数据存在编码不一致问题，故无法纳入诊断相关信息。
结局指标：本研究的主要结局为非计划住院。
研究对象：2013年12月前往伦敦内城区三家急诊科就诊的所有16岁及以上成年患者，共收集到19734例次独立就诊数据。
研究结果：其中19721例次（>99%）获得完整结局数据，6263例（32%）患者最终住院。以站点1作为入院风险分析的基线参照组。分析显示，站点2与站点3的入院风险显著更高（相对于站点1的调整后优势比（Adjusted Odds Ratio, AOR）：站点2为1.89，95%置信区间（Confidence Interval, CI）1.74~2.05，p<0.001）；黑人或英籍黑人种族的患者入院风险同样显著升高（AOR=1.29，95%CI 1.16~1.44，p<0.001）。贫困程度与住院风险存在强相关性。针对科室及全院工作量压力的分析结果存在矛盾，但距离“四小时目标”（英国国民保健制度（National Health Service, NHS）中限制急诊科患者滞留时间不超过4小时的规定）的远近成为本研究中入院决策的强影响因素（AOR=3.61，95%CI 3.30~3.95，p<0.001）。
研究结论：本研究发现，在校正各类患者人口统计学特征及就诊相关因素后，不同医院站点的入院优势比存在统计学显著差异，提示急诊科及临床医师层面的入院决策行为存在显著差异。四小时目标是急诊住院决策的强驱动因素。