(Dynamics of bed use in accommodating emergency admissions: stochastic simulation model)
(The rise in emergency admissions - crisis or artefact? Temporal analysis of health services data)
The National Health Service (NHS) must recognise that maintaining some empty beds, with staff on hand, is not wasteful, but a cost which must be incurred if a quality service to patients is to be sustained, say a team from the University of York in this week's BMJ. Adrian Bagust and colleagues argue that spare bed capacity is essential for the effective management of emergency admissions and the cost of doing so is an essential element of running an acute hospital service.
Bagust et al simulated emergency admissions in a hypothetical hospital in England using computer modelling. They found, not unexpectedly, that there was a rapid increase in the risk of there being no beds available for emergency patients when the hospital had a high occupancy level.
They conclude that emergency admissions are, by their nature, sporadic and difficult to predict and that their study suggests that spare capacity is essential if an emergency admissions service is to operate efficiently and at a level of risk acceptable to patients.
However, in a separate study also published in this week's BMJ a team from Bristol argues that "....whatever else is causing a real or perceived crisis in the NHS, an increase in the number of people requiring or demanding emergency treatment is not the explanation".
In an analysis of emergency admissions in an area served by Avon Health Authority, Dr Kieran Morgan and colleagues ascertained that the "....supposed rise in emergency admissions is almost entirely attributable to the increased reporting of internal transfers of patients after admission." They explain this by using the example that if someone who has suffered a stroke is transferred from an assessment ward to the care of a neurologist, then referred on to see other specialists, this single admission may be recorded as three or even four ‘episodes'. Because costs are attributed to episodes and not admissions, the cost of emergency care has risen dramatically during a period when capacity and demand have changed little, say the authors.
Despite their findings, the authors conclude that many patients and their carers have deeply unsatisfactory experiences when seeking access to emergency care. They say that it is important that their study is replicated elsewhere to establish whether the problem of emergency care is really one of changing demand or more a matter of the quality and accessibility of the capacity that is currently available.
Contact:
Mr Adrian Bagust, Deputy Director, York Health Economics Consortium, University of York ab13@york.ac.uk
Professor Stephen Frankel, Professor of Epidemiology and Public Health Medicine, Department of Social Medicine, University of Bristol, Bristol
Tel: 44-117-928-7203
Fax: 44-117-928-7325
stephen.frankel@bris.ac.uk