The continuing rise in emergency admissions

Capewell, Simon

doi:10.1136/bmj.312.7037.991

Cited by 122 publications

(94 citation statements)

References 5 publications

(6 reference statements)

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“…There had been a 20% increase in the ED attendances and ward admissions over the previous 5 years (Patient Management Taskforce 2001). This experience was similar to other metropolitan health services and international reports (Capewell 1996, Kendrick 1997, Morgan 1999. The expectation from the Victorian Government's Hospital Demand Management policy was that in response to specifically targeted funding of $10.44M ambulance diversion of emergency patients should be limited, whilst elective activity was maintained.…”

Section: Discussionsupporting

confidence: 55%

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Cameron¹,

Scown²,

Campbell³

2002

Aust. Health Review

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Section: Discussionsupporting

confidence: 55%

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Cameron¹,

Scown²,

Campbell³

2002

Aust. Health Review

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“…Changes in population age and levels of morbidity, and social changes such as decreasing support for the elderly and increasing social deprivation, account for only a proportion of the increase in emergency admissions in the UK [2,18,19] suggesting the role of other factors such as those within the formal health and social care system particularly in respect of managing long-term conditions [18]. We found that formal health service factors were significantly associated with emergency admissions among patients.…”

Section: Discussion the Findings In Relation To Other Studiesmentioning

confidence: 87%

“…The existing evidence suggests a continuing rise in emergency admissions [2,17,18] with some suggesting that all age groups and diagnostic categories are involved in the rising trend with major contributions from older medical and surgical patients, multiple admissions, and socially deprived groups. [2] However Morgan et al have observed that the rise in emergency admissions may be attributable to the increased reporting of internal transfers of patients after admission [19].…”

Section: Discussion the Findings In Relation To Other Studiesmentioning

confidence: 99%

“…Emergency hospital admissions have been increasing in the UK over recent years [1,2]. With the predicted increase of about 53% in the proportion of people aged 65 and over in the UK between 2001 and 2013 [3] this trend is set to continue as some evidence suggest that the ageing population structure will be associated with increases in the number and frequency of emergency admissions [4].…”

Section: Introductionmentioning

confidence: 99%

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Determinants of Emergency Hospital Admissions among Patients in Blackpool, England: Population-Based Cross-Sectional Study

Agboado¹,

Mills²

2011

J Clinic Res Bioeth

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Objectives: To examine the relative importance of patients' socio-demographic characteristics, health service factors, health conditions, day and season of admission as predictors of emergency admissions among Blackpool residents.Study design: Population-based cross-sectional study using routine patient admission data. Records of admissions among Blackpool patients were analysed to examine the effects of socio-demographic factors, health service factors, health conditions, day and season of admissions on emergency admissions. Principal results:The emergency admission risk has declined over the study period. Compared with admissions in people aged 35 to 44, admissions in those aged 85 and above were 3.2 times more likely to be emergencies. Admissions from 4th IMD quintile areas were 43% more likely to be emergencies compared with those from 2nd IMD quintile areas. Admissions among patients registered with Blackpool GPs were less likely to be emergencies compared with those registered with GPs outside Blackpool. Admissions to geriatric medical specialties were most likely to be emergencies. Emergency admission risk was highest for admissions attributed to accidents. Emergency admission risk was also highest for Saturday admissions and lowest for Wednesday admissions. No significant association was observed between emergency admissions and patients' sex. Conclusions:The risk of emergency admissions among Blackpool patients has declined over the period of this study. Socio-demographic and health service factors, health conditions, day and season of admission were independently associated with emergency admissions. [12]. A provider spell is the time that a patient stays with one hospital care provider from admission to discharge, transfer or death [13]. Records of admission spells for Blackpool patients over the period were extracted for analyses.Emergency admissions are admissions that are unpredictable and at short notice because of clinical needs [12]. Admissions classified as emergencies in this study were those coded as 21, 22, 23, 24 and 28 [12]. Primary diagnoses at admission were classified according to the World Health Organization's ICD-10 (International Classification of Disease, 10 th revision).[14] Specialty classifications used broadly followed those contained in the dataset [12] (see Appendix 1 for details). We used the ONS classification of the seasons used in the excess winter deaths calculations [15]. GP practices were coded A to V to eliminate the risk of identifying patients because of the relatively small practice list sizes.Postcodes of patients' places of residence were linked to their respective 2007 Indices of Multiple Deprivation (IMD) [16] which are composite scores derived from seven deprivation domains. The scores were further grouped into their corresponding national score quintiles -the higher the quintile the more deprived an area is. The resultant dataset was analysed to describe emergency admission patterns and identify factors associated with emergency admission. Statistica...

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“…[1][2] Similar systems for managing acute medical admissions exist across the UK and Ireland. After discharge from hospital, unplanned readmission is relatively common, with reported rates of 15.1% at 28 days from North East Thames, 3 38% at six months in London, 4 and 19.5% at one year from the west of Ireland.…”

Section: Introductionmentioning

confidence: 99%

Emergency medical readmission: long-term trends and impact on mortality

2011

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-There is increasing emphasis on prevention of emergency medical readmissions. The broad pattern of acute medical readmissions was studied over a seven-year period and the impact of any readmission on 30-day mortality was recorded. Significant predictors of outcome, including co-morbidity and illness severity score, were entered into a multivariate regression model, adjusting the univariate estimates of the readmission status on mortality. In total, 23,114 consecutive acute medical patients were admitted between 2002-8; the overall readmission rate was 27%. Readmission independently predicted an increased 30-day mortality; the odds ratio, was 1.12 (95% confidence interval (CI) 1.09 to 1.14). This fell to 1.05 (95% CI 1.02 to 1.08) when adjusted for outcome predictors including acute illness severity. The trend for readmissions was to progressively increase over time; the median times between consecutive admissions formed an exponential time series. Efforts to reduce or avoid readmissions may depend on an ability to modify the underlying chronic disease.KEY WORDS: chronic disease, hospital mortality, length of stay, medical admission, readmission IntroductionThere has been an increasing trend of emergency medical admissions in recent decades. 1-2 Similar systems for managing acute medical admissions exist across the UK and Ireland. After discharge from hospital, unplanned readmission is relatively common, with reported rates of 15.1% at 28 days from North East Thames, 3 38% at six months in London, 4 and 19.5% at one year from the west of Ireland. 5 The rising trend in emergency readmissions is worrying, partly because of implied implications about quality of care, but also because of the burden placed on the provision of acute hospital services. The cost savings associated with shortened hospital stay are lost when patients are re-hospitalised.There is great interest in the concept of the 'avoidable' readmission; many are said to cluster close to the first few weeks after an index discharge. 6 Although some medical readmissions can be ascribed to factors, such as suboptimal healthcare delivery or lack of social supports, many patient-or disease-related factors also have an impact. 7 The hypothesis that many readmissions are preventable is not established and the contribution of fresh events, in patients with chronic illness and frequent co-morbidity, must be considered. The use of readmissions as a benchmark of quality is controversial; it may be a poor guide to quality of care without correction for medical, social and demographic factors. 8 Many studies are of limited duration with very little data on the mortality among readmitted patients. In an attempt to address some of these questions from a longer-term perspective the pattern of admissions to St James's Hospital Dublin, were examined. A 'readmission' was defined as any emergency medical readmission in the seven years from beginning of 2002 to end of 2008. Methods BackgroundSt James's Hospital (SJH) operates a continuous sectorised acute general ...

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The continuing rise in emergency admissions

Cited by 122 publications

References 5 publications

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Determinants of Emergency Hospital Admissions among Patients in Blackpool, England: Population-Based Cross-Sectional Study

Emergency medical readmission: long-term trends and impact on mortality

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