(Is the emergency (999) service being misused? Retrospective analysis)
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The number of emergency admissions to hospitals in the UK has increased for reasons that are not fully understood. The ageing populations is not the principal cause, as demographic changes account for only five per cent of the increase and the increase is too steep to be explained by a worsening health of the nation. Other causes that have been suggested include, higher patient expectations and a rise in referrals by GPs ( GPs and hospital doctors both have an increasing fear of litigation). Also, falling death rates among patients who are admitted suggest that patients are being admitted with less serious problems than before.
In this week's BMJ Mann and Guly investigate whether an increase in 'inappropriate' calls accounts for the increase, in their four year study (1993-7) with the Westcountry Ambulance Service and Derriford Hospital in Plymouth. During this period 999 calls increased by 28 per cent, but the authors found that this was not due to inappropriate calls, as the numbers of patients admitted also increased (inappropriate calls would have led to a fall in admissions).
Mann and Guly conclude that none of the reasons suggested for the increase can explain the size of the rise, but as the increase in numbers is far in excess of the rise in bed capacity, there is an increase in the pressures on A&E departments and hospital wards.
Dr Clifford Mann, Senior Registrar, Department of Accident and Emergency Medicine, Derriford Hospital, Plymouth
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