The simple clinical score: a tool for benchmarking of emergency admissions in acute internal medicine

Abstract

Quality of care in intensive care and surgery has benefited from establishing comparative standards. At present there is no accepted tool to compare outcomes for emergency admissions in internal medicine. The Simple Clinical Score (SCS) was used in 1098 consecutive medical emergency admissions to adjust mortality for severity of illness. Hospital mortality adjusted for severity of illness and length of stay in the cohort was in keeping with mortality in the Irish derivation study with a trend towards lower mortality in the very high-risk group. Three parameters with poor reproducibility were identified. The SCS has several potential applications: identification of patients with low risk of death suitable for early hospital discharge; early identification of patients with a high risk of death, who will require care in critical care areas (or specialist palliative care); and benchmarking of acute medical departments internationally in a similar way to how APACHE II scoring has been used in critical care units worldwide.