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Rise in emergency hospital admissions is ‘unsustainable’

Submitted by Admin on August 14, 2010 - 12:56

Between 2004/05 and 2008/09, emergency hospital admissions rose by 11.8%. A report by the Nuffield Trust stresses that the increase is unsustainable, and examines possible reasons for the steep rise.

Emergency admissions to hospital cost the NHS around £11 billion per year, and the number is rising quickly. Between 2004/5 and 2008/09 there were 1.35 million extra emergency admissions.

Nuffield Trust Director Dr Jennifer Dixon said that reversing the increase in emergency admissions “must be the number one priority for the NHS in England – any reform to the health service that does not tackle this will fail.”

Why are hospital admissions increasing?

A large proportion of emergency admissions (roughly 40%) can be accounted for by the ageing population, and more by the increasing population of the UK. However, Nuffield points out that there is still a significant increase in admissions that is not explained by either of these factors.

Given that emergency admissions are one of the most expensive ways of treating people, the Nuffield report stresses that it is crucial that the NHS examine why emergency admissions are increasing so rapidly, and see if there is any way that savings can be made.

The Nuffield report suggests a number of reasons for the increase in admissions, including:

  • Increased public expectations leading to more self-referral to NHS care
  • the effects of incentives in the NHS such as central targets and new ways of paying hospitals. For instance, there is a suggestion that some hospitals were admitting patients so as to avoid going over the 4-hour target set for dealing with patients in A&E. This effectively resulted in patients being admitted for a few hours, when the aim of the target was to reduce accident and emergency waiting times.
  • changes in clinical decision-making and more ‘defensive’ medicine
  • increased ability to detect and treat illness
  • changes in data collection and recording
  • changes in care outside hospital such as general practice and social care.

One of their key findings is that there has been a dramatic increase in short-stay admissions – patients admitted for one day or less. The Nuffield Trust report concludes that this has partly been caused by lowering the threshold for emergency admissions (advances in medical care have freed up more hospital beds, allowing doctors to admit more patients), but that incentives to discharge patients could also have played an important role.

How can we reverse the trend?

The Nuffield report makes a number of recommendations for reducing costs in the face of the admissions rise. These include reforming the system for reimbursing hospitals to lower the incentive to admit patients unnecessarily, for instance admission of patients who have been waiting almost 4 hours, as mentioned above. Nuffield suggests a risk-adjusted system of payment, so that the risk and cost of admitting a patient is initially borne by the hospital, and any savings made from avoiding unnecessary admissions will be put back into the hospital.

They also recommend making improvements by examining NHS Trusts that have been successful in lowering their admissions, and working to spread this knowledge to those areas that have much higher than average admissions.

Preventing childhood accidents to reduce admissions

One of the key ways to reduce emergency hospital admissions is to work with relevant agencies to improve public health. As the Nuffield Trust report says: “Admitting a patient to hospital as an emergency case is costly and frequently preventable”.

From 2003-04 to 2007-08, the number of admissions of under 18s due to accidents in England increased by 3.9%, from c 129,000 to c 134,000. It is clear that by preventing childhood accidents, or taking measures to limit the serious consequences of accidental injury, we can reduce the total number of emergency hospital admissions.

More information

You can read the full report on the Nuffield website: Trends in emergency admissions in England 2004-2009: is greater efficiency breeding inefficiency?

Find out more about the rates of emergency admissions caused by accidents in the Resource Library: How many children are admitted to hospital because of accidents?