title: Does integrated emergency care reduce mortality and non-elective admissions? A retrospective analysis.
abstract: OBJECTIVE
  The authors reconfigured the emergency care system of Addenbrookes Hospital, Cambridge. The medical admissions unit and the emergency department (ED) have been combined into one emergency assessment unit. This paper aims to determine if reconfiguration has reduced non-elective hospital admissions and reduced mortality for non-elective admissions.
  
  
  METHODS
  A retrospective 'before and after' study in a teaching hospital. Routinely collected data were used to evaluate the effectiveness of this approach. Setting One acute trust in the UK. Main outcome measures Inhospital mortality rates and standardised admission ratios (SAR) between 2003 and 2009.
  
  
  RESULTS
  There was a significant trend towards improved survival, both for non-elective admissions and deaths in the ED (z=-3.92; p>0.001), despite the age and acuity of patients increasing. There was a marked decrease in the SAR. Formal complaints, incident reports and the proportion of patients leaving before treatment declined, whereas the proportion of patients re-admitted as an emergency within 28 days did not change.
  
  
  CONCLUSIONS
  Integrating emergency care within a hospital reduces hospital admissions, is associated with reduced inhospital mortality and a better quality of care.
authors.affiliation: Emergency Department, Addenbrookes Hospital, Hills Road, Cambridge CB2 2QQ, UK. adrian.boyle@addenbrookes.nhs.uk
authors.forename: Adrian
authors.initials: A
authors.lastname: Boyle
authors.forename: Jonathon
authors.initials: J
authors.lastname: Fuld
authors.forename: Vazeer
authors.initials: V
authors.lastname: Ahmed
authors.forename: Tom
authors.initials: T
authors.lastname: Bennett
authors.forename: Susan
authors.initials: S
authors.lastname: Robinson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000592:standards; D012189:Retrospective Studies; D006113:United Kingdom; D055815:Young Adult