Impact of a dedicated syncope and falls facility for older adults on emergency beds

Background: syncope and falls are common symptoms in older adults. Dedicated facilities for these symptoms are emerging in the UK. To date, justification for resource allocation for these day case facilities is lacking. A dedicated syncope and falls day case facility for older adults was set up in Newcastle in 1991 (at the Royal Victoria Infirmary). The facility provided rapid access for assessment of appropriate patients from the community, the accident and emergency department, or emergency admissions. Activity and performance in 1999 were compared with peer inner-city teaching hospitals and with previous performance in 1990 at the Royal Victoria Infirmary to determine whether the facility had influenced emergency activity. Objective: to describe the impact of the facility on emergency bed activity and performance for the diagnostic categories of syncope, falls, collapses, gait abnormalities and dizziness. Design: descriptive study. Setting: syncope and falls day case facility. Methods: performance and activity for Healthcare Resource Groups and ICD codes relevant to falls and syncope were compared for adults over 65 years attending the Royal Victoria Infirmary and thirteen peer hospitals. Activity and performance before the facility was set up (1990) at the Royal Victoria Infirmary were also compared with 1999 data. Results: syncope and collapse is the 6th commonest reason for acute hospital attendance of over 65-year olds in the UK. In 1999, the Royal Victoria Infirmary was at variance by-6616 bed days compared with other the other Trusts for these diagnoses. This equates to 18 beds occupied in that year. The degree of emergency activity for the relevant diagnoses (Healthcare Resource Groups data) was much less than at peer trusts-35% versus 97%. The average length of stay for admitted patients was also shorter for Royal Victoria Infirmary than peers-2.4 versus 8.6 days. Acute length of stay at the Royal Victoria Infirmary was reduced from 10.9 days in 1990 to 2.7 days in 1999 (ICD 10 data). In 1991 all activity was emergency. Conclusion: the striking variance in bed days in 1999 is due to lower emergency activity and shorter length of stay at the Royal Victoria Infirmary. This is attributed to the dedicated rapid access day-case facility. This has relevant resource implications for planning of future facilities and implementation of National Service Framework standards for falls and intermediate care.