How to select out ambulatory care patients from the general emergency medical intake prior to full assessment and investigations: A validation study of the Amb Score Ala L, Cogbill E, Marion R, Rahman R, Deibel F, Rathbone N Acute Medicine Department, Royal Glamorgan Hospital, LLantrisant, South Wales Background 1/3 of emergency referrals for admission are discharged on the same day1 but can these be predicated before full assessment takes place? 7 independent factors, collectively called the Amb Score2 were previously shown to identify potential same day discharges (within 12 hours) from the general medical intake –these patients could have been re-directed to the ambulatory care unit instead. Objectives Ambulatory Group Admission Group Number (%) 115 (35.5) 228 (65.5) Amb Score Factors* Female sex Age<80 Access to personal/public transport IV treatment not anticipated by referring doctor Not acutely confused MEWS score = 0 Not discharged within previous 30 days 75 108 109 106 113 77 106 97 136 132 82 198 72 187 Mean Total Amb Score (SD) 5.9 (1.2) 4.0 (1.2) OR (95% CI) 0.4(0.2-0.6) 0.2(0.1-0.3) 0.1(0.03-0.2) 0.1(0.03-0.1) 0.1(0.03-0.5) 0.2(0.1-0.4) 0.490.2-0.80 p=0.00005 p<0.00000 p<0.00000 p<0.00000 p=0.0001 p<0.00000 p=0.0032 p<0.00000 * Each of the 7 Amb Score factors if applicable is given a score of 1. Otherwise it scores 0. Maximum Amb Score 7. This study aims to verify and validate the Amb Score. Conclusions Methods The Amb Scores of emergency medical patients referred by GPs and A&E who were discharged within 12 hours (Ambulatory group) were compared with the scores of those who were admitted for ≥ 48 hours. Amb Score parameters were verified by chi-square analysis. AUROC was used to assess the performance of the score and to identify an appropriate cut-off level. The Amb Score has potential as another early assessment tool AUROC = 0.88 Results 1/3 of the patients were in the Ambulatory group. All the Amb Score parameters showed high statistical significance. The AUROC of the Amb Score was 0.88; a score of ≥ 5 has a sensitivity of 92.2 % in predicting potential ambulatory patients (specificity 64%). 1. St Noble VJ, Davies G, Bell D. Improving continuity of care in an acute medical unit: initial outcomes. QJM 2008;101:529-33 2. Ala L, Mack J, Shaw R, Gasson A. The Amb Score: A pilot to develop a scoring system to identify which emergency medical referrals would be suitable for Ambulatory care management. Acute Medicine 2010;9:141 (Abstract) Amb Score ≥ 5 is sensitive at selecting potential ambulatory care patients from the general medical in-take prior to full clerking and investigations It should be used in conjunction with clinical judgement 5th International Conference, Society for Acute Medicine (UK), London 29-30th September 2011