CHP Seminar - Prof. Andrew Street
Improving outcomes for older people with emergency and urgent care needs
Presenter: Prof. Andrew Street (London School of Economics)
Date & Time: Wednesday 25 August 4pm-5pm (AEST)
Via Zoom: https://unimelb.zoom.us/j/83796555483?pwd=eUNUa2J1QXE1bG10TlZoa29RWHkwZz09 Password: 457693
Older people with emergency and urgent care (EUC) needs, in particular those with frailty, are especially vulnerable to harms that can arise in this care pathway. In this seminar I present emerging findings from econometric analyses forming part of a wider study of EUC pathways for older people.
We use patient-level data covering 2011-2017 for more than 1.2m attendances by people aged 75+ to an emergency department (ED) in the Yorkshire and Humber region in England. We track the patient journey from the initial emergency call, ambulance journey, and admission to and discharge from the ED or hospital.
We analyse three ED outcomes: whether patients were seen within four hours of arrival; were admitted from ED to hospital; and ED re-attendance. The most important predictors were the call-handlers designation of the urgency of the patient´s condition.
For those admitted to hospital, we analyse length of stay (LoS), in-hospital mortality and 30-day readmission. We find that frailty, measured using the Hospital Frailty Risk Score (HFRS), is a powerful predictor of LoS and in-hospital mortality, but less so of emergency readmissions.
The econometric analysis has identified ED sites exemplifying promising pathways that now are the subject of qualitative fieldwork and also supports development of a system dynamics computer simulation model to be used to evaluate EUC interventions in different settings.
This work is supported by NIHR grant 17/05/96.