Differences in managing urgent and elective admissions with regard to diagnosis related groups and patient age

Aims: To analyse the management behaviour differences between

urgent and elective admissions (respectively, UA and

EA) in the most frequent conditions in the Spanish hospital

practise and their relation to the patients’ age.

Methods: Observational, descriptive, cross-sectional study carried

out in public acute-patient hospitals throughout Spain in the year

2002. the Diagnosis-Related Groups were further subgrouped as

“high-prevalence” (HP-DRG, the 25 most frequent ones) and “remaining”

(remaining-DRG). The parameters compared were mean

duration of hospital admission, DRG weight, number of secondary

diagnoses, number of procedures and mortality, as related to the

type of admission (UA, EA), the DRG subgroup (HP-DRG or remaining-

DRG) and the patients’ age.

Results: HP-DRG cases encompass 33.5% of the case population.

As compared to EA’s, UA’s are characterised by older age

(p<0.001), a higher proportion of males, higher-weighted DRG’s, and generating a longer mean duration of admission, a greater number of secondary diagnoses and a greater number of procedures (p<0.001 in all three cases). The severity, complexity, resource consumption and expense of UA’s in the “remaining-DRG” subgroup reach their maximum in the 65-69-year age group and then decrease, while all three parameters increase uniformly with age among the HP-DRG. Conclusions: These data highlight the potential relevance of the management role of health care professional in the emergency areas and the need for alternatives to conventional hospital admission for the more frequent conditions causing UA’s, the grouping whereof should facilitate their clinical and economic management.