Twelve-month outcomes of patients admitted to the acute general medical service at Groote Schuur Hospital.
OBJECTIVE
Hospitalisation for medical illness has ongoing impact on individuals, healthcare services and society beyond discharge. This study's objective was to determine the 12-month mortality and functional outcomes of patients admitted to the acute medical service at Groote Schuur Hospital (GSH).


METHODS
Follow-up, using the hospital records system and provincial death registry, together with telephonic interviews or home visits, was attempted for 465 medical inpatients admitted to GSH between 14 September and 16 November 2009. Functional outcomes were assessed using the Katz activities of daily living (ADL) score and Barthel index (BI). Outcome measures. The major study outcomes included: 12-month mortality (overall and unexpected), changes in functional status and pre- and post-admission employment rates.


RESULTS
Inpatient mortality was 11%. At 12-month follow-up, 35% (145/415) were deceased and 30% (125/415) could not be traced; 38% (55/145) of deaths were considered expected and unexpected mortality was associated with age >40 years (p=0.02) and an admission urea >7.0 mmol/l (p=0.004). Katz ADL deteriorated in 15% (21/143) of interviewed patients and was associated with age >50 years (p=0.005); 23% (33/143) had improved Katz ADL associated with admission human immunodeficiency virus (HIV) (p=0.01), tuberculosis (TB) infection (p=0.05) and sepsis (p=0.02). Employment rates declined from 41% (59/145) pre-admission to 18% (26/145) at 12 months (p<0.001), with little increase in the number of persons receiving disability grants. Twenty per cent (29/145) of patients required hospital readmission and this was associated with ADL functional decline (p=0.01).


CONCLUSIONS
There was a very high overall mortality of 42% in patients admitted to the general medical wards. Significant employment decline and readmission rates highlight the additional economic and societal burdens of hospitalisation due to medical illness in the survivors.
Department of Medicine, University of Cape Town.
H
H
Stuart-Clark
N
N
Vorajee
S
S
Zuma
L
L
Van Niekerk
V
V
Burch
P
P
Raubenheimer
J G
JG
Peter
D000203:Activities of Daily Living; D000328:Adult; D000367:Age Factors; D000368:Aged; D016001:Confidence Intervals; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000175:diagnosis; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data; D018805:Sepsis / Q000175:diagnosis; D013019:South Africa / Q000453:epidemiology; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis; D014508:Urea / Q000097:blood
D014508:Urea