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Review
. 2014 Nov;107(11):432-8.
doi: 10.1177/0141076814542669.

Emergency hospital admissions via accident and emergency departments in England: time trend, conceptual framework and policy implications

Thomas E Cowling  1 , Michael A Soljak  2 , Derek Bell  3 , Azeem Majeed  2
Affiliations
Review

Emergency hospital admissions via accident and emergency departments in England: time trend, conceptual framework and policy implications

Thomas E Cowling et al. J R Soc Med. 2014 Nov.
No abstract available

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Figures

Figure 1.
Figure 1.
Proportion of Emergency Admissions in which Patients were Admitted via A&E, or via a GP, in England, 2001–02 to 2010–11. Data are from Hospital Episode Statistics (HES), a national administrative database containing details of all admissions to NHS hospitals in England. The primary care sensitive conditions (PCSCs) analysed were: angina; asthma; cellulitis; congestive heart failure; convulsions and epilepsy; chronic obstructive pulmonary disease; dehydration and gastroenteritis; dental conditions; diabetes complications; ear, nose and throat infections; gangrene; hypertension; influenza and pneumonia; iron-deficiency anaemia; nutritional deficiency; other vaccine-preventable diseases; pelvic inflammatory disease; perforated/bleeding ulcer; and pyelonephritis, as defined by Purdy, in addition to dementia and atrial fibrillation as defined in the NHS Outcomes Framework.
Figure 2.
Figure 2.
A Possible Conceptual Framework for Explaining the Growing Role of A&E Departments as Portals for Emergency Admission. The arrows represent the movement of patients through time, from one quadrant to another, in a possible conceptual framework to explain the increased proportion of emergency admissions to NHS hospitals via A&E (top left). (A) The clinical need for hospital admission via A&E is increasing due to demographic changes; (B) Patients who would previously have been managed in A&E without admission to hospital are now admitted; (C) Increased failure of management in primary care and outpatient settings that is unexplained by changes in population demographics; (D) Patients who would previously have been admitted via a GP or consultant outpatient clinic are now (recorded as being) admitted via A&E.
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References

    1. NHS England. The Evidence Base from the Urgent and Emergency Care Review. 2013. See http://www.england.nhs.uk/wp-content/uploads/2013/06/urg-emerg-care-ev-b... (last checked 28 August 2014).
    1. UK Government. Prime Minister Announces £500 Million to Relieve Pressures on A&E. See https://www.gov.uk/government/news/prime-minister-announces-500-million-... (last checked 28 August 2014).
    1. National Audit Office. Emergency Admissions to Hospital: Managing the Demand. 2013. See http://www.nao.org.uk/wp-content/uploads/2013/10/10288-001-Emergency-adm... (last checked 28 August 2014).
    1. Committee of Public Accounts. Forty-Sixth Report: Emergency Admissions to Hospital. See http://www.publications.parliament.uk/pa/cm201314/cmselect/cmpubacc/885/... (last checked 28 August 2014).
    1. NHS England. Weekly A&E SitReps 2013–14. See http://www.england.nhs.uk/statistics/ae-waiting-times-and-activity/weekl... (last checked 28 August 2014).

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