Winter emergency admissions to Medical and Paediatric wards.

Michael Loudon and Helen Ward, General Practitioners, New Ollerton, Notts, England.

Acknowledgments: Drs Loudon and Ward are grateful to King's Mill Centre and to Bassetlaw Hospital for information supplied.

This paper was originally published in the British Journal of Health Care Management, who have kindly given permission for its reproduction here.
Reference: "Winter Referrals: Emergency Admission Patterns. M Loudon and H Ward, BJHCM 2001: 7; 231-235.

Short Introduction

Every winter, hospital managers will hope that patient admission rates, even if heavy, are not exceptional. And when, inevitably, admission rates do rise, some will ask GPs to request fewer admissions, to ease the secondary care load. But is this possible ? Are any admissions by GPs avoidable ? Are any unnecessary ? For the sick patient, is home an alternative to hospital ?

Main Introduction

In early 1999 in North Nottinghamshire, during a relatively minor Influenza epidemic, general practitioners [GPs], their out of hours co operative services [Co-ops], and local hospitals and social services all buckled under the strain of increased winter workload. The problem seemed likely to recur in future winters so we decided to investigate our general practice's use of hospital emergency admission services during the winter months. Several questions seemed relevant:

• Do rates of admission vary between practices locally ?
• How does our practice admission rate compare ?
• How many of our patients require repeated admissions ?
• Were these new episodes of illness or were they re-admissions of patients who has been discharged 'too early' ?

When hospitals are busy, and bed space is short, GPs are sometimes asked to try and reduce their admission rates. Is this possible ? Are any admissions 'unnecessary' ? The two main questions addressed by our study are:

• Could hospital admission be avoided by a change in [GP] clinical management of illness episodes ?
• Could Nursing Home admission provide an alternative to emergency hospital admission ?

The authors of a recent cross sectional study from Merton, Sutton and Wandsworth Health Authority ( Reid et al (1999) ) concluded that the variation in hospital admission rates between different general practices "was largely explained by differences in patient populations." If so, the clinical behaviour of individual GPs may vary less than some expect, and variations in admission rates may not reflect 'unnecessary' use of hospital acute services.