Marie Curie says that the NHS is struggling to cope with A&E admissions of people who are in the last year of their lives. The charity says the situation will hit crisis point if care provided in the community is not significantly improved.
New data collected by Marie Curie has revealed there were over 1.6 million emergency admissions for people in the last year of their life in Britain in 2016, costing the NHS £2.5 billion and amounting to around 11 million days in hospital.
With an ageing population, the charity predicts the number of people dying each year is going to go up significantly over the next 20 years. This means the cost of emergency admissions for people in the last year of life could almost double.
These admissions could cost the NHS an extra £2 billion, and up to 8,000 extra hospital beds could be needed by 2038 – the equivalent of an extra ward in every hospital with a major A&E unit, dedicated solely to emergency beds for dying people.
Full story : Emergency hospital admissions at the end of life set to sky rocket | Marie Curie
Full briefing: Emergency admissions: Data briefing | Marie Curie
The number of emergency admissions to hospital in England and Wales has risen sharply in recent years and is a matter of concern to clinicians, policy makers and patients alike. However, the factors that influence this decision are poorly understood | BMJ Open
Findings: Departmental factors such as busyness, time of day and levels of senior support were identified as non-clinical influences on a decision to admit rather than discharge patients. The 4-hour waiting time target, while overall seen as positive, was described as influencing decisions around patient admission, independent of clinical need. Factors external to the hospital such as a patient’s social support and community follow-up were universally considered powerful influences on admission. Lastly, the culture within the ED was described as having a strong influence (either negatively or positively) on the decision to admit patients.
Conclusion: Multiple factors were identified which go some way to explaining marked variation in admission rates observed between different EDs. Many of these factors require further inquiry through quantitative research in order to understand their influence further.
Full reference: Pope, I. et al. (2017) A qualitative study exploring the factors influencing admission to hospital from the emergency department. BMJ Open. 7:e011543.
Harron K, Gilbert R, Cromwell D, et al. International comparison of emergency hospital use for infants: data linkage cohort study in Canada and England
BMJ Qual Saf Published Online First: 12 June 2017. doi: 10.1136/bmjqs-2016-006253
Objectives To compare emergency hospital use for infants in Ontario (Canada) and England.
Methods We conducted a population-based data linkage study in infants born ≥34 weeks’ gestation between 2010 and 2013 in Ontario (n=253 930) and England (n=1 361 128). Outcomes within 12 months of postnatal discharge were captured in hospital records. The primary outcome was all-cause unplanned admissions. Secondary outcomes included emergency department (ED) visits, any unplanned hospital contact (either ED or admission) and mortality. Multivariable regression was used to evaluate risk factors for infant admission.
Results The percentage of infants with ≥1 unplanned admission was substantially lower in Ontario (7.9% vs 19.6% in England) while the percentage attending ED but not admitted was higher (39.8% vs 29.9% in England). The percentage of infants with any unplanned hospital contact was similar between countries (42.9% in Ontario, 41.6% in England) as was mortality (0.05% in Ontario, 0.06% in England). Infants attending ED were less likely to be admitted in Ontario (7.3% vs 26.2%), but those who were admitted were more likely to stay for ≥1 night (94.0% vs 55.2%). The strongest risk factors for admission were completed weeks of gestation (adjusted OR for 34–36 weeks vs 39+ weeks: 2.44; 95% CI 2.29 to 2.61 in Ontario and 1.66; 95% CI 1.62 to 1.70 in England) and young maternal age.
Conclusions Children attending ED in England were much more likely to be admitted than those in Ontario. The tendency towards more frequent, shorter admissions in England could be due to more pressure to admit within waiting time targets, or less availability of paediatric expertise in ED. Further evaluations should consider where best to focus resources, including in-hospital, primary care and paediatric care in the community.
Full text is available here