National survey of use of hospital beds by adolescents aged 12 to 19 in the United Kingdom

In contrast to North America and Australia, little attention has been paid to the use of health services by adolescents in the United Kingdom. The incidence of survival from chronic illness in young people is increasing. The care of adolescents is becoming a quality issue for the NHS.¹,² Health data are rarely available in the United Kingdom on adolescents as a separate group, with standard data dividing young people into those aged under 14 years or those aged 15-44 years.³ A study of the use of psychiatric beds by adolescents in England and Wales is presently being undertaken by the Royal College of Psychiatrists (A O'Herlihy, personal communication). Previous regional studies have been undertaken,⁴,⁵ but reliable national data to guide the provision of other hospital services to adolescents are not available.

Participants, methods, and results

I requested information on the numbers of hospital bed days of inpatients and day case patients aged 12 to 19 years from April 1997 to March 1998 from all health authorities and boards in Wales and Scotland and 27 randomly selected ones from England. I excluded admissions for obstetrics, mental health, and learning disabilities. Information was provided by 37 health authorities and boards (response rate 79%), including three of the five in Wales, all 15 health boards in Scotland, and 19 English health authorities and boards, including at least one from each of the eight English regions. Information from three health authorities and boards was unusable. Average bed days was calculated by summing data from all 34 included health authorities and boards (population 15.8 million). I used two sample t tests to analyse differences in means. Data were normally distributed.

Total inpatient bed days per 10 000 people increased significantly from 17.0 (SD 7.4) at 12 years to 24.6 (SD 7.7) at 19 years (t=-4.5, P<0.000) (figure). Bed days for males were significantly higher than females at age 12 years; however, bed usage by females surpassed that of males from 17 years. Bed days for females but not males increased significantly during adolescence. Total bed days of day cases per 10 000 people increased significantly from 2.32 (SD 1.82) at 12 years to 4.31 (SD 1.38) at 19 years (t=-6.8, P<0.000). I found no increase in bed days of male day cases during adolescence, however in females bed days increased significantly between 12 and 19 years. Females used significantly more bed days as day cases than did males from 16 years onwards. Bed day usage (inpatient and day case) was not related to the population of the health authority.

Data from all Scottish health boards (population 5.2 million) allowed calculations of the use of inpatient beds per 10 000 people of a specific age. Bed day use increased significantly from 1604.2 (SD 100.5) per 10 000 12 year olds to 2099.4 (SD 82.1) per 10 000 19 year olds (t=-3.4, P<0.005). I found no significant differences between sexes. Total inpatient bed use was 3732.5 per 10 000 young people aged 12-19 years.

Comment

Adolescents aged 12 to 19 years occupy an average of 18 inpatient beds and 2.2 day case beds in a district general hospital nominally serving 250 000 people. The use of hospital beds increases rather than decreases through adolescence. This contradicts the assumption that adolescents use hospitals rarely and do not merit separate facilities. An average district general hospital has the activity to support a ward for adolescents of 12 to 15 beds. Overall, 12.8 inpatient beds are required for each 10 000 adolescents aged 12 to 19 years in the hospital catchment area (based on standard assumptions of an 80% bed occupancy). Although dedicated wards for adolescents may not be possible in many hospitals, the provision of other facilities should be considered.

Figure.

Bed days of adolescent inpatients and day case patients per 10 000 population by age and sex

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