Reducing emergency admissions: are we on the right track?

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

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 …