Emergency admissions in Stockport were exaggerated

Editor—Morgan et al say that the increase in emergency admissions in Avon from 1989 to 1998 may be an artefact.¹ Analyses in the annual public health report for Stockport reached a similar, but not identical, conclusion.²

We found that the increases were exaggerated. Information distortions, interhospital transfers, increasing rates of admission for minor conditions, and changed patterns of flow affecting a particular provider unfairly accounted for almost two thirds of the apparent increase, leaving a true underlying pressure of 2.5% a year. Part of this increase was explained by changed practice—for example, improved management of chest pain—and part was unexplained.

The unexplained increase was entirely among elderly people. A rapid response scheme for acute care at home was put in place jointly by health and social services. For the first six months that the scheme was in place there was no year on year increase in emergency admissions for the population of Stockport. Since our original response last year,³ however, this halt has not been sustained and the pattern of emergency admissions has shifted towards younger age groups. This shift has not yet been fully analysed.

Patterns of emergency admission are complex. They require active management but this must not simply assume a constantly rising pressure. Investment in community services is relevant to a whole system approach.