The high number of unplanned R-coded admissions occurring within the context of rapidly rising admissions amongst older people has attracted policy attention internationally focussed on admission reduction strategies.
Patient characteristics did not predict R-coding, but organisational features, particularly admission via the ED, out of normal GP hours and via general internal medicine, were important and may offer opportunity for admission reduction strategies.
Ill-defined conditions admissions have been highlighted as a target for admission reduction strategies under the assumption that they are a consequence of increased prevalence of inadequately managed chronic disease in the ageing population and because they may be avoidable through improved chronic disease management in the community [ 6, 17].
It appears that the benefit of CCT intervention on admission reduction is confined to musculoskeletal conditions such as back pain (OR 0.56) and lower limb pain (OR 0.63); or to conditions likely to be episodic and resolved by the time the patient has arrived in ED such as angina (OR 0.71).
Admission £9, reductions £7.50.
While surgical delay has been investigated for other groups of fracture patients (Streubel et al. 2011, Menendez and Ring 2014), there have not been any similar investigations regarding reduction in surgical delay for dislocated arthroplasties, except comparing reduction at the emergency department to admission and reduction in theater (Frymann et al. 2005, Gagg et al. 2009, Lawrey et al. 2012).
A follow-up MRI 3 weeks after admission showed reduction in size of the ischaemic changes (Fig. 1).
Follow-up MRI, DWI (c) and T2-weighted image (d) 3 weeks after admission demonstrating reduction of ischaemic changes Fig. 2 MRI, T2-weighted image (a) and CT (b) of the brain after 6 months demonstrating a large infarction in the left hemisphere.
Delay to long-term admission or reduction in day care are possible primary outcomes as these are well recorded.
Understanding the frail elderly can help prevent the progression of disability and reduce the risk of unplanned hospitalizations, nursing home admissions and reductions in cost of medical care delivery to this population.
