Paul Robinson: Are hospital admissions out of control?
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Hospital admissions in England have grown 6% from 2007/8 to 2008/9, faster than the average annual growth in prior years. Emergency admissions have increased 5% which is higher than previous years, with short stay emergencies now accounting for half of all admissions. The data suggests the growth is real and not just more readmissions of the same patients. While ambulatory care may be able to reduce some admissions, the Christmas period data implies hospitals may be able to reduce admissions at other times as well.
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Paul Robinson: Are hospital admissions out of control?
- 1. Are hospital admissions out of control? Paul Robinson Head of Market Intelligence 8 June 2010 www.chks.co.uk
- 2. Main elements Overview Electives (briefly) Emergencies E i Short stay emergencies in some detail
- 3. (Previous analysis published in the HSJ Jan 2010) Overall growth (with Wales and N. Ireland comparators) g ( p ) % growth 08/9 Average annual growth in Combined on 07/8 preceding 3 years England 6.0% 4.6% Wales 5.4% 1.3% N. Ireland 3.7% 2.9% Emergencies England 5.0% 2.4% Wales W l 1.4% 1 4% 0.7% 0 7% N. Ireland 3.5% 0.9% Electives England 6.7% 6.0% Wales 9.1% 1.9% N. N Ireland 3.9% 3 9% 3.8% 3 8%
- 4. Emergency admissions per 1,000 population 120 110 100 England E l d 90 N. Ireland Wales 80 70 60 2005 2006 2007 2008 2009
- 5. Change in emergency admissions 2007/8 - 2008/09 by PCT All England HES Average 5.0% 30% 25% 20% 15% 10% 5% 0% -5% -10% -15%
- 6. Change in emergency admissions 2004/5 - 2008/09 by PCT All England HES 70% 60% 50% 40% 30% 20% 10% 0% -10% -20%
- 7. Proportion of short stay emergencies. (All England HES) 0 LoS 1 LoS Other 2007 26% 22% 52% 2008 27% 22% 51% 2009 28% 22% 50%
- 8. Emergency admissions England Jan 07 - Dec 09 500 450 400 350 All 0LOS usands 300 1LOS >1LoS Thou 250 200 150 100 50 0 Jan-07 Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09
- 9. England - All emergencies by source of admission 350 300 250 A&E 200 GP Thousands Other 150 100 50 0 Jan-07 Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09
- 10. Growth in 0 LoS by specialty type 30000 25000 A&E 20000 Medicine Paeds Surgical 15000 10000 5000 0 Jan 07 Apr 07 Jul 07 Oct 07 Jan 08 Apr 08 Jul 08 Oct 08 Jan 09 Apr 09 Jul 09 Oct 09 Jan 10 Jan-07 Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09 Jan-10
- 11. Wales - All emergencies by source of admission 18000 16000 14000 12000 10000 A&E 8000 GP 6000 Other text Linear (A&E) 4000 2000 0 Jan 07 Apr 07 Jul 07 Oct 07 Jan 08 Apr 08 Jul 08 Oct 08 Jan 09 Apr 09 Jul 09 Oct 09 Jan-07 Apr-07 Jul-07 Oct-07 Jan-08 Apr-08 Jul-08 Oct-08 Jan-09 Apr-09 Jul-09 Oct-09
- 12. N. Ireland - All emergencies by source of admission 12000 10000 8000 A&E GP Other 6000 4000 2000 0 Jan 07 Apr 07 Jan-07 Apr-07 Jul 07 Jul-07 Oct 07 Jan 08 Apr 08 Oct-07 Jan-08 Apr-08 Jul 08 Jul-08 Oct 08 Jan 09 Apr 09 Oct-08 Jan-09 Apr-09 Jul 09 Jul-09 Oct 09 Oct-09
- 13. %age method of admission = GP by Trust (England) average = 20% 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Variation in recording is potentially distorting source of admission analysis. Trusts with <5% admissions from GP seem unlikely.
- 14. Is t e g o t in pat e ts o just ad ss o s s the growth patients or admissions? Emergencies - England 05/06 06/07 07/08 08/09 Growth Admissions (000s) 4,624 4,660 4,728 4,963 7.3% No. f ti t N of patients 3,368 3 368 3,381 3 381 3,409 3 409 3,553 3 553 5.5% 5 5% Pts as % admissions 72.8% 72.6% 72.1% 71.6% Admissions per pt 1.37 1.38 1.39 1.40 Clearly it is not just the same patients returning more often
- 15. Is ambulatory care the right target? (Based on the NHS III Ambulatory Care Directory) East Kent – 2008/09 Pts eligible for emergency ambulatory care = 26770 Total emergency admissions = 72815 % EAM = 37 Leeds – 2008/9 Pts eligible for emergency ambulatory care = 17759 Total emergency admissions = 82983 % EAM = 21
- 16. The impact of Christmas 40% 35% 30% 25% 20% 15% 10% 5% 0% If we can achieve this on Christmas Eve – why not the rest of the year?
- 17. In summary: England larger growth than Wales & N. Ireland – but all have had a recent growth surge The growth is in all lengths of stay g g y – but short stay now 50% of all admissions A&E admissions appear to be the source of the rise – but big variation in pathways/recording(?) Surgery and P d are growing S d Paeds i – it is not just A&E and Medicine