Variations and inter-relationship in outcome from emergency admissions in England: a retrospective analysis of Hospital Episode Statistics from 2005-2010.

BACKGROUND: The quality of care delivered and clinical outcomes of care are of paramount importance. Wide variations in the outcome of emergency care have been suggested, but the scale of variation, and the way in which outcomes are inter-related are poorly defined and are critical to understand how best to improve services. This study quantifies the scale of variation in three outcomes for a contemporary cohort of patients undergoing emergency medical and surgical admissions. The way in which the outcomes of different diagnoses relate to each other is investigated. METHODS: A retrospective study using the English Hospital Episode Statistics 2005-2010 with one-year follow-up for all patients with one of 20 of the commonest and highest-risk emergency medical or surgical conditions. The primary outcome was in-hospital all-cause risk-standardised mortality rate (in-RSMR). Secondary outcomes were 1-year all-cause risk-standardised mortality rate (1 yr-RSMR) and 28-day all-cause emergency readmission rate (RSRR). RESULTS: 2,406,709 adult patients underwent emergency medical or surgical admissions in the groups of interest. Clinically and statistically significant variations in outcome were observed between providers for all three outcomes (p < 0.001). For some diagnoses including heart failure, acute myocardial infarction, stroke and fractured neck of femur, more than 20% of hospitals lay above the upper 95% control limit and were statistical outliers. The risk-standardised outcomes within a given hospital for an individual diagnostic group were significantly associated with the aggregated outcome of the other clinical groups. CONCLUSIONS: Hospital-level risk-standardised outcomes for emergency admissions across a range of specialties vary considerably and cross traditional speciality boundaries. This suggests that global institutional infra-structure and processes of care influence outcomes. The implications are far reaching, both in terms of investigating performance at individual hospitals and in understanding how hospitals can learn from the best performers to improve outcomes

The Southern Region burn disaster plan.

A regional burn disaster plan for 24 burn centers located in 11 states comprising the Southern Region of the American Burn Association was developed using online and in-person collaboration between burn center directors during a 2-year period. The capabilities and preferences of burn centers in the Southern Region were queried. A website with disaster information, including a map of regional burn centers and spreadsheet of driving distances between centers, was developed. Standard terminology for burn center capabilities during disasters was defined as open, full, diverting, offloading, or returning. A simple, scalable, and flexible disaster plan was designed. Activation and escalation of the plan revolves around the requirements of the end user, the individual burn center director. A key provision is the designation of a central communications point colocated at a burn center with several experienced burn surgeons. In a burn disaster, the burn center director can make a single phone call to the communications center, where a senior burn surgeon remote from the disaster can contact other burn centers and emergency agencies to arrange assistance. Available options include diversion of new admissions to the next closest center, transfer of patients to other regional centers, or facilitation of activation of federal plans to bring burn care providers to the affected burn center. Cooperation between regional burn center directors has produced a simple and flexible regional disaster plan at minimal cost to institute or operate

Reducing Avoidable Deaths Among Veterans: Directing Private-Sector Surgical Care to High-Performance Hospitals

Objectives. We quantified older (65 years and older) Veterans Health Administration (VHA) patients’ use of the private sector to obtain 14 surgical procedures and assessed the potential impact of directing that care to high-performance hospitals