Admission of asthma patients after treatment at an Emergency Department Treatment Centre (EDTC) in Singapore

1. Admission of asthma patients after treatment at an Emergency Department Treatment Centre (EDTC) in Singapore LATHY PRABHAKARAN1, CHAN S P2, JANE C1, ABISHEGANANDED J3, LIM G H4 TAN W L4 Department of Nursing1,Clinical Research Unit2 Respiratory Medicine3, Emergency Medicine4 Tan Tock Seng Hospital, Singapore

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

3. Literature Review • Emergency short stay units have been present in the ED worldwide for several decades. • Shown to reduce length of stay1-4, improve EDefficiency5, be cost effective6 and reduce the number of inpatient admissions7.

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

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

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

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

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

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

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

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

12. Statistical Analysis • Software: Stata 10.1 • Method: Multiple logistic regression • All tests conducted at 5% level of significance

13. Outcome of asthma cases admitted to EDTC Flow Chart 2:

14. Results Table 1: Demographic Characteristics

15. Results Table 2: Factors associated with admission to hospital after treatment at EDTC * * Multiple logistic regression analysis adjusted for demographics (age, gender and ethnicity) • None of the considered factors (demographics and prior ED attendance was • significantly associated with admission

16. Results Flow Chart 3: • 3% of patients were readmitted post 40days of discharged. • This readmission rate was non-significantly lower than that of discharged patients (5.5%; p:0.41).

17. Results • Comparison of Length of Stay • Patients Discharged VS Transferred to ward 1 : 3.4 • safe discharge of 73% of patients. • No of beds saved = 181(discharged)

18. Results • 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

19. Conclusion • 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 • safe discharge of 73% of patients. • saved 181 beds. • 3% of patients were readmitted post 40days of discharged. • This readmission rate was non-significantly lower than that of discharged patients (5.5%; p:0.41).

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