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Objective: To investigate factors predictive of short hospital admissions and appropriate placement to inpatient versus clinical decision units (CDUs).Method: This is a retrospective analysis of attendance and discharge data from an inner-city ED in England for December 2013. The primary outcome was admission for less than 48 hours either to an inpatient unit or CDU. Variables included: age, gender, ethnicity, deprivation score, arrival date and time, arrival method, admission outcome and discharge diagnosis. Analysis was performed by cross-tabulation followed by binary logistic regression in three models using the outcome measures above and seeking to identify factors associated with short-stay admission.Results: There were 2119 (24%) admissions during the study period and 458 were admitted for less than 24 hours. Those who were admitted in the middle of the week or with ambulatory care sensitive conditions (ACSCs) were significantly more likely to experience short-stays. Older patients and those who arrived by ambulance were significantly more likely to have a longer hospital stay. There was no association of length of inpatient stay with being admitted in the last 10 min of a 4 hours ED stay.Conclusion: Only a few factors were independently predictive of short stays. Patients with ACSCs were more likely to have short stays, regardless of whether they were admitted to CDU or an inpatient ward. This may be a group of patients that could be targeted for dedicated outpatient management pathways or CDU if they need admission. [ABSTRACT FROM AUTHOR]

Objective The number of emergency admissions to hospital in England and Wales has risen sharply in recent years and is a matter of concern to clinicians, policy makers and patients alike. However, the factors that influence this decision are poorly understood. We aimed to ascertain how non-clinical factors can affect hospital admission rates. Method We conducted semistructured interviews with 21 participants from three acute hospital trusts. Participants included 11 emergency department (ED) doctors, 3 ED nurses, 3 managers and 4 inpatient doctors. A range of seniority was represented among these roles. Interview questions were developed from key themes identified in a theoretical framework developed by the authors to explain admission decision-making. Interviews were recorded, transcribed and analysed by two independent researchers using framework analysis. Findings Departmental factors such as busyness, time of day and levels of senior support were identified as non-clinical influences on a decision to admit rather than discharge patients. The 4-hour waiting time target, while overall seen as positive, was described as influencing decisions around patient admission, independent of clinical need. Factors external to the hospital such as a patient's social support and community follow-up were universally considered powerful influences on admission. Lastly, the culture within the ED was described as having a strong influence (either negatively or positively) on the decision to admit patients. Conclusion Multiple factors were identified which go some way to explaining marked variation in admission rates observed between different EDs. Many of these factors require further inquiry through quantitative research in order to understand their influence further. [ABSTRACT FROM AUTHOR]

Objective To investigate factors associated with unscheduled admission following presentation to emergency departments (EDs) at three hospitals in England. Design and setting Cross-sectional analysis of attendance data for patients from three urban EDs in England: a large teaching hospital and major trauma centre (site 1) and two district general hospitals (sites 2 and 3). Variables included patient age, gender, ethnicity, deprivation score, arrival date and time, arrival by ambulance or otherwise, a variety of ED workload measures, inpatient bed occupancy rates and admission outcome. Coding inconsistencies in routine ED data used for this study meant that diagnosis could not be included. Outcome measure The primary outcome for the study was unscheduled admission. Participants All adults aged 16 and older attending the three inner London EDs in December 2013. Data on 19 734 unique patient attendances were gathered. Results Outcome data were available for 19 721 attendances (>99%), of whom 6263 (32%) were admitted to hospital. Site 1 was set as the baseline site for analysis of admission risk. Risk of admission was significantly greater at sites 2 and 3 (adjusted OR (AOR) relative to site 1 for site 2 was 1.89, 95% CI 1.74 to 2.05, p<0.001) and for patients of black or black British ethnicity (AOR 1.29, 1.16 to 1.44, p<0.001). Deprivation was strongly associated with admission. Analysis of departmental and hospital-wide workload pressures gave conflicting results, but proximity to the “4-hour target” (a rule that limits patient stays in EDs to 4 hours in the National Health Service in England) emerged as a strong driver for admission in this analysis (AOR 3.61, 95% CI 3.30 to 3.95, p<0.001). Conclusion This study found statistically significant variations in odds of admission between hospital sites when adjusting for various patient demographic and presentation factors, suggesting important variations in ED-level and clinician-level behaviour relating to admission decisions. The 4-hour target is a strong driver for emergency admission. [ABSTRACT FROM AUTHOR]

The article reports on a serious threat to social wellbeing and human health posed by climate change. It is noted that physicians and health professionals play an important role in ensuring that climate change is properly understood by policy makers. The impact of human activity on unequivocal global warming is discussed.

Aims: To assess the feasibility of implementing and sustaining the WHO guidelines for inpatient management of severe malnutrition in under-resourced rural South African hospitals, and to identify any constraints. Intervention: Three 2-day training workshops were held in 1998, followed by monthly 1 -day visits for 5 months, ending in March 1 999, in two rural district hospitals with limited resources in Eastern Cape Province, South Africa. Methods: A 12-month observational study was conducted from April 2000 to April 2001 in Mary Theresa and Sipetu hospitals (Eastern Cape Province, South Africa), including 1011 child-hours of observation on the wards, medical record reviews, interviews with carers and staff, and inventories of essential supplies. All admissions (n = 193) for severe malnutrition to the two hospitals were studied. The main outcomes were the extent to which the 10 steps for routine care of severely malnourished children were implemented, proficiency of performance and constraining factors. Results: The hospitals made the changes required in clinical and dietary management, but the tasks were not always performed fully or with sufficient care. Play and stimulation and an effective system of follow-up were not implemented. Doctors' poor knowledge, nurses' inattentiveness and insufficient interaction with carers were constraints to optimal management. The underlying factors were inadequate undergraduate training, understaffing, high doctor turnover and low morale. Conclusions: Guidelines for severe malnutrition are largely feasible but training workshops are insufficient to achieve optimal management as staff turnover and an unsupportive health system erode the gains made and doctors treat cases without having being trained. Medical and nursing curricula in Africa must include treatment of severe malnutrition. [ABSTRACT FROM AUTHOR]

The author reflects on the issues that responsible practices and hospitals will have to address given the increase in the number of asylum seekers reaching Great Britain. It cites the need for government departments to make use of standard handheld records of medical information taken during selection for relocation and ensure that the data follow the patients to their new practitioners. It notes the need for health professionals to offer the highest standard of healthcare to this population.

The article presents questions and answers related to climate change research is presented including the relation of global warming towards the expansion of Antarctic sea ice, sea level rise, and cooling of the stratosphere.

Objective: To investigate factors associated with unscheduled admission following presentation to Emergency Departments (EDs) at three hospitals in England.Design and Setting: Cross-sectional analysis of attendance data for patients from three urban EDs in England: a large teaching hospital and major trauma centre (Site 1), and two district general hospitals (Sites 2 and 3). Variables included: patient age, gender, ethnicity, deprivation score, arrival date and time, arrival by ambulance or otherwise, a variety of ED workload measures, inpatient bed occupancy rates and admission outcome. Coding inconsistencies in routine ED data used for this study meant that diagnosis could not be included.Outcome Measure: The primary outcome for the study was unscheduled admission.Participants: All adults aged 16 and over attending the three inner London EDs in December 2013. Data on 19 734 unique patient attendances were gathered.Results: Outcome data were available for 19 721 attendances (>99%), of whom 6263 (32%) were admitted to hospital. Site 1 was set as the baseline site for analysis of admission risk. Risk of admission was significantly greater at Sites 2 and 3 (AOR relative to Site 1 for Site 2 was 1.89, 95% CI:1.74 to 2.05, p<0.001), and for patients of black or black British ethnicity (1.29, 1.16-1.44, p<0.001). Deprivation was strongly associated with admission. Analysis of departmental and hospital-wide workload pressures gave conflicting results, but proximity to the 'four-hour target' (a rule that limits patient stays in EDs to four hours in the NHS in England) emerged as a strong driver for admission in this analysis (3.61, 3.30-3.95, p<0.001).Conclusion: This study found statistically significant variations in odds of admission between hospital sites when adjusting for various patient demographic and presentation factors, suggesting important variations in ED- and clinician-level behaviour relating to admission decisions. The four-hour target is a strong driver for emergency admission. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the proposed amendment to the Prisons Act by the Israeli parliament and the compliance of the Israeli Medical Association (IMA) to the said legislation.

Discusses the access to antiretroviral drug treatment in Africa. Demand of treatment for patients with HIV and AIDS in Africa; Challenges in meeting these demands; What should and should not be done in approaches to providing treatment.

The author discusses a report to be published by the Intergovernmental Panel on Climate Change (IPCC) regarding the impacts of global warming. The report outlines the future threats of further global warning that include increased scarcity of food and fresh water, extreme water events and rise in sea level. It suggests for health professionals to push their own organisations to divest from fossil fuel industries and change the minds and behavior of others in positions of influence.

The author discusses health reforms which lead to commercialization in the pubic health of South Africa. The author says that the African National Congress adapted new health reforms as the National Health Service (NHS) undergo transformation. He states that the reforms pushed competition, financial motive and private capital instead of protecting the public health over commercialization. He adds that the critic of the reforms labelled them as commercialisation not as being anti-privatisation.

The article offers information on Health and Social Care Bill. It mentions the significance of writing a letter to the House of Lords in the Great Britain to protect National Health Service (NHS) as the bill did not deliver quality and fairness. It mentions that the healthcare needs of the entire population has been evaluated by public health professionals. It also discusses several problems related to the bill which includes the abolishment of direct accountability.