A prospective observational study on emergency medical admissions at Mater Dei Hospital, Malta

Abstract

BACKGROUND: Ambulatory Emergency Care is a novel healthcare paradigm that has not yet been adopted locally. The aim of this study was to determine how many patients admitted to medical wards in Mater Dei Hospital between January 2020 and December 2020 could have been managed in an ambulatory setting.

METHODS: We determined which patients had a length of stay of less than 24 hours as well as calculated the 'Amb score' for each patient, postulating these two criteria as effective markers of patients that could be selected for ambulatory management. With the unfolding of the COVID-19 worldwide pandemic, data collection stopped in March 2020. A total of 54 patients were randomly sampled from post-take medical ward rounds and data pertaining to their medical admission was recorded.

RESULTS: 20.37% of patients had a length of stay of less than 24 hours whilst 44.4% of patients had an Amb score of 5 or more. 18.5% of patients were found to have an Amb score of 5 or more AND a length of stay of less than 24 hours. A moderate negative correlation (rs = -0.66) between a high Amb Score and a short length of stay was demonstrated. Lower respiratory tract infection and chest pain were the two commonest provisional diagnoses making up 37.0% of all admissions.

CONCLUSIONS: 1 in every 4.6 patients could benefit from ambulatory emergency management. We hypothesize that such a service would help reduce pressures on the current local healthcare system, improving emergency department throughput and patient satisfaction.