Analysis

Reducing emergency admissions: are we on the right track?

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6017 (Published 18 September 2012) Cite this as: BMJ 2012;345:e6017
  1. Martin Roland, professor of health services research,
  2. Gary Abel, research associate
  1. 1Cambridge Centre for Health Services Research, University of Cambridge CB2 8PN, UK
  1. Correspondence to: M Roland mr108{at}cam.ac.uk
  • Accepted 1 September 2012

Most attempts to reduce emergency hospital admissions are focused on people at high risk. Martin Roland and Gary Abel highlight the misconceptions behind this approach and suggest what to do about them

Emergency admissions are a popular target in the drive to improve quality of care and save money. In the NHS rates of admission from primary care practices are under increasing scrutiny because it is widely believed that many admissions could be avoided by better primary care. However, evidence about what is effective is lacking, and misconceptions may lead to naïve or unrealistic expectations of what can be achieved.

Problem of rising admissions

Emergency or unscheduled admissions have been rising for several years (fig 1), with emergency admissions commoner among elderly people and those with comorbidities.1 2 In part the rise results from changes in the health service that may have nothing to do with patients’ health. For example, introduction of a target in 2004 that patients should wait no longer than four hours in emergency departments has been seen as a cause of increased short stay emergency admissions.3 In addition, hospitals had incentives to improve data collection systems after emergency admissions were included in their payment schedules in 2006-07.4

Fig 1 Emergency admissions to NHS hospitals in England, 2000-112

Nevertheless, some of the increase seems to be real, and improving primary care could prevent a significant number of people being admitted as emergencies. It has been estimated that around £2.3bn (€2.9bn; $3.7bn) could be saved by reducing admissions among “frequent fliers”—patients with multiple hospital admissions, who are believed to use a disproportionate share of resources.5 Most interventions involve identifying patients at risk of admission and providing a case manager—for example, a community matron—to support them. But there are some fundamental flaws in this approach, as we …

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