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Unnecessary hospital admissions through the emergency department (ED) are substantial, underestimated, and often an unmonitored problem. Within our organisation, early reports suggest that almost 10 per cent of patients admitted to General Medicine are discharged within 24 hours, so called zero day admissions.
We agree with Torjesen that better preventative care outside the hospital is of the utmost importance and minimising disparities in the socioeconomic determinants of health within societies benefits overall health outcomes and reduces dependence on complex, unnecessary and expensive hospital treatments. It however cannot be ignored that competing demands and attempts to meet National Emergency Access Targets places added strain and pressure on Emergency Department staff to admit patients who, after further assessment and management in the ED may have been able to be sent home.
A multi-faceted approach is essential; both to improve the definition of patients truly requiring multi-day hospitalisation and to better manage patients in the community. This requires consideration of strategies such as higher acuity outpatient clinics, stronger community care and enhanced hospital admission risk reduction programs. Strengthening socioeconomic elements and supported discharge processes for admitted patients is imperative to minimising not only the cost burden of unnecessary hospitalisations through emergency departments but also the antecedent risks associated with this.
Competing interests:
No competing interests
15 June 2018
Vikas Wadhwa
Clinical Director of Integrated Services
Morven Duncan, Associate Program Director, Acute and Aged Medicine
Eastern Health
Arnold Street, Box Hill, Victoria, 3128, Australia
Re: Almost 1.5m emergency hospital admissions could have been avoided last year
Unnecessary hospital admissions through the emergency department (ED) are substantial, underestimated, and often an unmonitored problem. Within our organisation, early reports suggest that almost 10 per cent of patients admitted to General Medicine are discharged within 24 hours, so called zero day admissions.
We agree with Torjesen that better preventative care outside the hospital is of the utmost importance and minimising disparities in the socioeconomic determinants of health within societies benefits overall health outcomes and reduces dependence on complex, unnecessary and expensive hospital treatments. It however cannot be ignored that competing demands and attempts to meet National Emergency Access Targets places added strain and pressure on Emergency Department staff to admit patients who, after further assessment and management in the ED may have been able to be sent home.
A multi-faceted approach is essential; both to improve the definition of patients truly requiring multi-day hospitalisation and to better manage patients in the community. This requires consideration of strategies such as higher acuity outpatient clinics, stronger community care and enhanced hospital admission risk reduction programs. Strengthening socioeconomic elements and supported discharge processes for admitted patients is imperative to minimising not only the cost burden of unnecessary hospitalisations through emergency departments but also the antecedent risks associated with this.
Competing interests: No competing interests