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A unified approach to clinical testing in acute medical admissions may protect health resources

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Doctors studying patient profile and organisational factors in relation to hospital stay in Northern Ireland have concluded that a systematic approach to requesting clinical investigations would help to conserve health resources.

A median stay of seven days (interquartile range 3–12 days) for emergency admissions to a medical ward was significantly extended for patients who were elderly, managed in a medical word, or admitted on a Friday. Consultants’ requests for chest x ray examinations and echocardiography also lengthened median stay—from six to eight days; so did type of primary disease: tumours, congestive heart failure, stroke, and respiratory disease—from six to nine days or more. Taken together in a multivariate analysis, older age (⩾75 v <63 years) or having a tumour was over three times more likely to predict a stay of eight days or more, and having a respiratory condition over one and a half times more likely. Perhaps surprisingly, significant variation among consultants in ordering tests did not affect hospital stay. Nevertheless, unifying test requests still offers potential scope for saving resources, say the study’s authors.

This study was a prospective observational study of emergency admissions to the medical ward of one Belfast teaching hospital over six months in 2000. Data were collected during post-take ward rounds after admission. The study covered 830 hospital stay episodes in patients (mean age 64.5 (SD18.0) years).

Whether demographic and organisational factors affect hospital stay has not been reported in the UK. Elsewhere their effect has been noted separately, but not together.

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