Admissions from emergency departments rise as four hour target approachesBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4931 (Published 19 November 2009) Cite this as: BMJ 2009;339:b4931
All rapid responses
The four hour wait is only one of many potential factors fuelling the
year on year rise in hospital admission rates.(1) The highest rises are in
young children, many of whom are admitted through emergency departments
(AEDs).(2;3) Children account for 30% of AED contacts and in up to 60% of
cases, their parents have not sought advice from a GP prior to
attending.(4) This year, we reported substantial (20%) increases in
unplanned hospital admission rates in England among children aged< 10
years from a period (1996 to 2007) spanning these changes.(5) The majority
of admissions were due to short stay isolated minor infectious illness
episodes. The increases in admissions are not explained by greater
efficiency from trusts since the proportion of children admitted for
greater than 2 days has fallen by only 12%, hence the 41% expansion in
short stay admissions lasting less than 2 days suggests a true increase.
We would argue that many of these episodes could have been more
appropriately dealt with in primary and community settings and a crude
estimate of the costs of potentially avoidable admissions is in excess of
£60 million per year. Simply increasing resources in emergency departments
is not going to stem this rising tide. A number of emerging models of care
may provide possible solutions including traditional GP led care,
polyclinics and dedicated paediatric assessment units, which have been
estimated to reduce up to 15% of admissions.(6) In all but the most urgent
cases it should be possible to stream minor illness and injury in children
away from hospital AEDs they reach A and E.
(1) Mooney H. Admissions from emergency departments rise as four hour
target approaches. BMJ 2009; 339(nov19_2):b4931.
(2) NHS Institute for Innovation and Improvement. Focus on: emergency
and urgent care pathway for children and young people. 2008. Coventry,
NHS Institute for Innovation and Improvement. 1-3-2009.
(3) Chief Nursing Officer's Directorate CF&MA. Trends in children and
young people's care: Emergency admission statistics, 1996/97 - 2006/07,
England. 2008. England, TSO.
(4) Tadros S, Wallis D, Sharland M. Lack of use for advice by parents
results in increasing attendance to the paediatric emergency department.
Arch Dis Child 2009; 94(6):483.
(5) Saxena S, Bottle A, Gilbert R, Sharland M. Increasing Short-Stay
Unplanned Hospital Admissions among Children in England; Time Trends
Analysis. PLoS ONE 2009; 4(10):e7484.
(6) Healthcare for London, Commissioning Support for London. Meeting
the needs of children and young people; guide for commissioners. 2009.
Competing interests: No competing interests