Trends in emergency admissions

Editor—Morgan et al report that they find little evidence for a rise in emergency admissions from NHS data returns.¹ Their conclusion is that much of the increase in admissions is due to internal transfer between consultants generating multiple finished consultant episodes for an individual patient's admission. My memory suggests that this was a prediction raised in letters to the BMJ when the finished consulting episode first became a recognised measure of hospital activity.

In accident and emergency our level of information technology is often more basic and our workload is dependent on the number of people passing through the department. I have simple number data for the accident and emergency departments that I have worked in during the period in question (figure). In two departments there has been an 85% increase in the number of patients admitted. The percentage of patients admitted from the total seen in the departments has risen in all from 11% in the late 1980s to 17% in the late 1990s.

From the accident and emergency medicine view, more patients are attending the departments and more of these patients are admitted despite, or perhaps because of, an increase in the seniority of the doctors who receive them. During this period the specialty of accident and emergency medicine has matured, with the expansion of training schemes, an increase in the number of consultants, and the development of its own faculty.

If official statistics do not show the trends seen by the simple counting of patients through a department, where does the discrepancy lie? Are we on the shop floor incorrect in our assessment of the workload, or does the processing of the data returned from our departments somehow lose the message contained?

Figure.

Numbers of patients admitted from accident and emergency in three hospitals, 1986-97: absolute numbers (top) and percentage of all attenders (bottom)