Abstract / Description of output
Objectives
Multimorbidity is associated with poor health outcomes, and is increasing in prevalence, posing challenges for time-critical decision-making in the emergency department (ED) due to increasing patient complexity. This study describes the impact of multimorbidity in people attending ED on adverse patient-centred outcomes.
Methods and Analysis
Cohort study of adults attending EDs in NHS Lothian in Scotland 2012-2019, using linked ED, hospital discharge, cancer registry and national mortality data. Multimorbidity was defined as ≥2 conditions from the Elixhauser Index. Multivariable logistic or linear regression was used to assess associations of multimorbidity with 30-day mortality (primary outcome), hospital admission, 7-day ED reattendance and time spent in ED (secondary outcomes). Primary analysis was stratified by age (<65 vs ≥65years).
Results
451,291 people had 1,273,937 attendances to EDs during the study period. 43,504 (9.6%) had multimorbidity, and people with multimorbidity were older (median 73 vs 43yr), more likely to arrive by emergency ambulance (57.8% vs 23.7%), and to be triaged “very urgent” (23.5% vs 9.2%). After adjusting for other prognostic covariates, multimorbidity was associated with higher 30-day mortality (8.2% vs 1.2%, adjusted Odds Ratio (aOR) 1.81,95%CI 1.72-1.91), higher rate of hospital admission (60.1% vs 20.5%, aOR 1.81,95%CI1.76-1.86), higher 7-day ED reattendance (7.8% vs 3.5%, aOR 1.41,95%CI1.32-1.50) and longer time spent in department (adjusted coefficient 0.27 hours,95%CI0.26-0.27). Magnitude of associations between multimorbidity and all outcomes were larger in younger patients (eg 30-day mortality aOR 3.03,95%CI2.68-3.42 in <65s vs 1.61,95%CI1.53-1.71 in ≥65s.
Conclusion
Almost one in ten patients presenting to ED were multimorbid using Elixhauser Index conditions. Multimorbidity was strongly associated with adverse outcomes and these associations were stronger in younger people. The increasing prevalence of multimorbidity in the population is likely to exacerbate strain on emergency departments unless practice and policy evolve to meet the growing demand. People with multimorbidity in EDs may benefit from improved recognition and tailored care pathways.
Multimorbidity is associated with poor health outcomes, and is increasing in prevalence, posing challenges for time-critical decision-making in the emergency department (ED) due to increasing patient complexity. This study describes the impact of multimorbidity in people attending ED on adverse patient-centred outcomes.
Methods and Analysis
Cohort study of adults attending EDs in NHS Lothian in Scotland 2012-2019, using linked ED, hospital discharge, cancer registry and national mortality data. Multimorbidity was defined as ≥2 conditions from the Elixhauser Index. Multivariable logistic or linear regression was used to assess associations of multimorbidity with 30-day mortality (primary outcome), hospital admission, 7-day ED reattendance and time spent in ED (secondary outcomes). Primary analysis was stratified by age (<65 vs ≥65years).
Results
451,291 people had 1,273,937 attendances to EDs during the study period. 43,504 (9.6%) had multimorbidity, and people with multimorbidity were older (median 73 vs 43yr), more likely to arrive by emergency ambulance (57.8% vs 23.7%), and to be triaged “very urgent” (23.5% vs 9.2%). After adjusting for other prognostic covariates, multimorbidity was associated with higher 30-day mortality (8.2% vs 1.2%, adjusted Odds Ratio (aOR) 1.81,95%CI 1.72-1.91), higher rate of hospital admission (60.1% vs 20.5%, aOR 1.81,95%CI1.76-1.86), higher 7-day ED reattendance (7.8% vs 3.5%, aOR 1.41,95%CI1.32-1.50) and longer time spent in department (adjusted coefficient 0.27 hours,95%CI0.26-0.27). Magnitude of associations between multimorbidity and all outcomes were larger in younger patients (eg 30-day mortality aOR 3.03,95%CI2.68-3.42 in <65s vs 1.61,95%CI1.53-1.71 in ≥65s.
Conclusion
Almost one in ten patients presenting to ED were multimorbid using Elixhauser Index conditions. Multimorbidity was strongly associated with adverse outcomes and these associations were stronger in younger people. The increasing prevalence of multimorbidity in the population is likely to exacerbate strain on emergency departments unless practice and policy evolve to meet the growing demand. People with multimorbidity in EDs may benefit from improved recognition and tailored care pathways.
| Original language | English |
|---|---|
| Article number | e000731 |
| Number of pages | 14 |
| Journal | BMJ Medicine |
| Volume | 3 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 17 Aug 2024 |