ObjectiveTo identify trends in emergency admissions for patients with clinical conditions classed as ‘ambulatory care sensitive’ (ACS) and assess if reductions might be due to improvements in preventive care.DesignObservational study of routinely collected hospital admission data from March 2001 to April 2011. Admission rates were calculated at the population level using national population estimates for area of residence.ParticipantsAll emergency admissions to National Health Service (NHS) hospitals in England from April 2001 to March 2011 for people residents in England.Main outcome measuresAge-standardised emergency admissions rates for each of 27 specific ACS conditions (ICD-10 codes recorded as primary or secondary diagnoses).ResultsBetween April 2001 and March 2011 the number of admissions for ACS conditions increased by 40%. When ACS conditions were defined solely on primary diagnosis, the increase was less at 35% and similar to the increase in emergency admissions for non-ACS conditions. Age-standardised rates of emergency admission for ACS conditions had increased by 25%, and there were notable variations by age group and by individual condition. Overall, the greatest increases were for urinary tract infection, pyelonephritis, pneumonia, gastroenteritis and chronic obstructive pulmonary disease. There were significant reductions in emergency admission rates for angina, perforated ulcers and pelvic inflammatory diseases but the scale of these successes was relatively small.ConclusionsIncreases in rates of emergency admissions suggest that efforts to improve the preventive management of certain clinical conditions have failed to reduce the demand for emergency care. Tackling the demand for hospital care needs more radical approaches than those adopted hitherto if reductions in emergency admission rates for ACS conditions overall are to be seen as a positive outcome of for NHS.

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The early recognition and goal-directed management of severely septic patients has been shown to reduce mortality. This study aimed to determine compliance with the ‘Surviving Sepsis' guidelines and to analyse the systems involved in delivering care in a UK teaching hospital. Patients from any hospital department with clinically significant positive blood cultures (n=229) were identified. Adults who met criteria for severe sepsis and who were deemed suitable for active management were included (n=46). None of the patients received all bundle elements within the advised time limits. Only 52% had received broad-spectrum antibiotics within three hours of presentation and only 57% had adequate fluid resuscitation within six hours. The median time from presentation to doctor involvement was 1.1 hours, with a delay of 3.9 hours to see a senior clinician. The median time from presentation to admission to the high dependency unit (HDU) or intensive care unit (ICU) was 12.9 hours. This study has shown that the early recognition and resuscitation of septic patients is unreliable and the capacity to provide early antimicrobial and goal-directed therapy for septic patients is limited in a UK teaching hospital.