Tag: Emergency Care

Characteristics of children who are frequent users of emergency departments in England

Increasing pressures on emergency departments present a considerable challenge worldwide, particularly during winter. Before the COVID-19 pandemic, serious infectious disease incidence had fallen with the success of vaccination programmes. However, amidst the ongoing global pandemic pressure on hospital EDs are stretched to their limit. This can strain health resources and budgets and can result in poor clinical outcomes. Increasing demand for EDs may be driven by rising morbidity in an ageing population, poor access to primary care and increase in patient expectations. In England, in 2017/2018, there were 23.8 million  emergency department attendances, an increase of 22% since 2008/2009; rises were higher in the under-5 (28%–30%), and one-third of all British children visit an  emergency department each year. Such increases pose immense challenges to the National Health Service (NHS) amidst significant cuts in funding, given that that nearly half of the health budget is spent on emergency and acute care.

We conducted an observational study using routine administrative data. Hospital Episode Statistics (HES) data covering all attendances at NHS hospitals in England for the period April 2014–March 2017 were used. We published our study in the Emergency Medicine Journal We found that one in 11 children (9.1%) who attended an  emergency department attended four times or more in a year. Infants, boys and children living in more deprived areas had greater likelihood of being a frequent attender. We concluded that infants and children living in deprived areas have greater likelihood of being frequent attenders. Interventions that support parents and contribute to reducing avoidable emergency department attendance, particularly among infants, are crucial to provide appropriate support to users of emergency departments.

DOI: http://dx.doi.org/10.1136/emermed-2019-209122

Proportion of emergency admissions via A & E increasing while the proportion via GPs falling

In a paper published in the Journal of the Royal Society of Medicine, a team from Imperial College London examined time trends in emergency hospital admissions via accident and emergency departments in England. The proportion of emergency hospital admissions in which patients were admitted via an A and;E department increased markedly in England between 2001–2002 and 2010–2011.

There are several possible explanations for this trend. These include coding changes and the greater use of A and E departments to assess patients before they are admitted as emergencies. Changes in access to general practitioners – both during normal working hours and out of hours – may also have contributed to these changes.

The findings of the study in the JRSM are similar to those from studies in the United States. Future health policy should address gatekeeping in A  and E departments and the provision of urgent care in general practice  New models of care such as urgent care services that employ GPs in A and E departments as the gatekeepers to specialist urgent care may help in addressing this challenge but must be evaluated before they are scaled up.

The article was covered in Pulse and GP.