Centenary of the UCT Faculty of Health Sciences

Twelve-month outcomes of patients admitted to the acute general medical service at Groote Schuur Hospital

H Stuart-Clark, N Vorajee, S Zuma, L van Niekerk, V Burch, P Raubenheimer, J G Peter

Abstract


Objectives. Hospitalisation for medical illness has ongoing impact on individuals, healthcare services and society beyond discharge. This study’s objective was to determine the 12-month mortality and functional outcomes of patients admitted to the acute medical service at Groote Schuur Hospital (GSH).
Methods. Follow-up, using the hospital records system and provincial death registry, together with telephonic interviews or home visits, was attempted for 465 medical inpatients admitted to GSH between 14 September and 16 November 2009. Functional outcomes were assessed using the Katz activities of daily living (ADL) score and Barthel index (BI).
Outcome measures. The major study outcomes included: 12-month mortality (overall and unexpected), changes in functional status and pre- and post-admission employment rates.
Results. Inpatient mortality was 11%. At 12-month follow-up, 35% (145/415) were deceased and 30% (125/415) could not be traced; 38% (55/145) of deaths were considered expected and unexpected mortality was associated with age >40 years (p=0.02) and an admission urea >7.0 mmol/l (p=0.004). Katz ADL deteriorated in 15% (21/143) of interviewed patients and was associated with age >50 years (p=0.005); 23% (33/143) had improved Katz ADL associated with admission human immunodeficiency virus (HIV) (p=0.01), tuberculosis (TB) infection (p=0.05) and sepsis (p=0.02). Employment rates declined from 41% (59/145) pre-admission to 18% (26/145) at 12 months (p<0.001), with little increase in the number of persons receiving disability grants. Twenty per cent (29/145) of patients required hospital readmission and this was associated with ADL functional decline (p=0.01).
Conclusions. There was a very high overall mortality of 42% in patients admitted to the general medical wards. Significant employment decline and readmission rates highlight the additional economic and societal burdens of hospitalisation due to medical illness in the survivors.

Authors' affiliations

H Stuart-Clark,

N Vorajee, Department of Medicine, University of Cape Town

S Zuma, Department of Medicine, University of Cape Town

L van Niekerk, Department of Medicine, University of Cape Town

V Burch, Department of Medicine, University of Cape Town

P Raubenheimer, Department of Medicine, University of Cape Town

J G Peter, Department of Medicine, University of Cape Town

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Keywords

12-month outcomes, mortality, general medical in-patients

Cite this article

South African Medical Journal 2012;102(6):549-553.

Article History

Date submitted: 2012-01-13
Date published: 2012-05-23

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