title: Age and admission times as predictive factors for failure of admissions to discharge-stream short-stay units.
abstract: OBJECTIVE
  Discharge-stream emergency short-stay units (ESSU) improve ED and hospital efficiency. Age of patients and time of hospital presentations have been shown to correlate with increasing complexity of care. We aim to determine whether an age and time cut-off could be derived to subsequently improve short-stay unit success rates.
  
  
  METHODS
  We conducted a retrospective audit on 6703 (5522 inclusions) patients admitted to our discharge-stream short-stay unit. Patients were classified as appropriate or inappropriate admissions, and deemed successful if discharged out of the unit within 24 h; and failures if they needed inpatient admission into the hospital. We calculated short-stay unit length of stay for patients in each of these groups. A 15% failure rate was deemed as acceptable key performance indicator (KPI) for our unit.
  
  
  RESULTS
  There were 197 out of 4621 (4.3%, 95% CI 3.7-4.9%) patients up to the age of 70 who failed admission to ESSU compared with 67 out of 901 (7.4%, 95% CI 5.9-9.3%, P < 0.01) of patients over the age of 70, reflecting an increased failure rate in geriatric population. When grouped according to times of admission to the ESSU (in-office 06.00-22.00 hours vs out-of-office 22.00-06.00 hours) no significant difference rates in discharge failure (4.7% vs 5.2%, P = 0.46) were noted.
  
  
  CONCLUSIONS
  Patients >70 years of age have higher rates of failure after admission to discharge-stream ESSU. Although in appropriately selected discharge-stream patients, no age group or time-band of presentation was associated with increased failure rate beyond the stipulated KPI.
authors.affiliation: Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Emergency Medicine Research Unit, Sydney, New South Wales, Australia; NHMRC Centre for Research Excellence in Critical Infection, Westmead Millennium Institute for Medical Research, Sydney, New South Wales, Australia.
authors.forename: Amith L
authors.initials: AL
authors.lastname: Shetty
authors.forename: Savitha Banagar
authors.initials: SB
authors.lastname: Shankar Raju
authors.forename: Arsalan
authors.initials: A
authors.lastname: Hermiz
authors.forename: Milan
authors.initials: M
authors.lastname: Vaghasiya
authors.forename: Matthew
authors.initials: M
authors.lastname: Vukasovic
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D054869:Clinical Audit; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
keywords: access block; efficiency; organisational; patient discharge; patient flow; short-stay unit