title: Selecting ambulatory emergency care (AEC) patients from the medical emergency in-take: the derivation and validation of the Amb score.
abstract: Accurate prediction of the likelihood of same-day discharge could make it possible to direct one-third of the medical in-take to an ambulatory care unit, thereby facilitating bed management. In Phase 1 of this study, we identified seven independent factors that contribute to an ambulatory care score (Amb score) that can potentially be used as a tool to select ambulatory emergency care (AEC) patients from the medical emergency in-take. A high score was associated with discharge within 12 hours of assessment and treatment in hospital. In Phase 2, we verified and internally validated the performance of the Amb score in a different cohort of patients, finding that it functioned well in identifying early discharges (ie AEC patients), with an area under the receiver operator curve (AUROC) of 0.91 (95% CI 0.88-0.94). An Amb score of > or = 5 has a sensitivity of 96% (95% CI 90-98) and a specificity of 62% (95% CI 55-68) in identifying potential AEC patients.
authors.affiliation: Department of Acute Medicine, Royal Glamorgan Hospital, South Wales. lesala99@yahoo.co.uk
authors.forename: Les
authors.initials: L
authors.lastname: Ala
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mack
authors.forename: Rachel
authors.initials: R
authors.lastname: Shaw
authors.forename: Andrea
authors.initials: A
authors.lastname: Gasson
authors.forename: Emma
authors.initials: E
authors.lastname: Cogbill
authors.forename: Rose
authors.initials: R
authors.lastname: Marion
authors.forename: Rasha
authors.initials: R
authors.lastname: Rahman
authors.forename: Francesca
authors.initials: F
authors.lastname: Deibel
authors.forename: Nia
authors.initials: N
authors.lastname: Rathbone
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics; D019540:Area Under Curve; D003695:Delivery of Health Care / Q000379:methods; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010343:Patient Admission; D010351:Patient Discharge; D018579:Patient Selection; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods; D014218:Triage / Q000379:methods*