Annex 1
EMERGENCY MEDICAL ADMISSIONS IN WALES
INTRODUCTION
1. A considerable amount of top NHS management attention
and effort was invested in responding to the increase in emergency
admissions in 1996-97. As a result, the preparation for and the
handling of emergency pressures markedly improved and patients
were better served than in previous years.
PROGRESS MADE
2. A report in July of action taken in 1996-97 highlighted
that:
- the development of emergency admissions task forces
in each area had led to positive results; and
- emergency medical patients were better served and there
was a marked reduction in hospital closures.
3. Task forces working collectively concluded that there
had been:
- clearer views of what happened in each area;
- better levels of co-operation in tackling problems;
- better monitoring of information; and
- progressive strategic planning and more GP involvement.
1996-97
4. A 3 per cent increase in emergency medical admissions
on the previous year was reported in 1996-97, with the greatest
increases along the M4 corridor in south Wales.
| | 1995-96 outturn |
1996-97 outturn | Increased cases from 95-96 to 96-97
| % increase between 95-96 and 96-97 |
| Gwent* | 17,978 | 18,902
| 915 | 5.1 |
| Morgannwg | 24,356 | 25,027
| 671 | 2.8 |
| Dyfed Powys | 19,577 | 19,966
| 389 | 2.0 |
| Bro Taf | 36,445 | 38,261
| 1,816 | 5.0 |
| North Wales** | 28,925 |
28,917 | (8) | 0
|
| All Wales | 127,281 | 131,073
| 3,792 | 3.0 |
*Gwent Hospitals only
**North Wales Hospitals only
5. Contract levels established the previous year were
generally sufficient to meet overall demand. For those hospitals
with severe capacity problems in 1995-96, health authorities invested
in emergency admissions units and in the provision of extra beds
to be deployed at critical times. These eased the problems significantly,
reducing or eliminating decisions to close to admissions.
1997-98
6. The report noted a number of factors likely to affect
performance in 1997-98 including:
- higher levels in Summer referrals;
- issues of data quality and validation;
- relationships with social services departments and arrangements
for community care packages;
- staffing issues including nurse recruitment problems
and junior doctors' training;
- impact of emergency admissions on elective work and
waiting times; and
- relationship of emergency activity on GP fundholder
elective work.
CONTINUING ISSUES
FOR 1997-98
7. In addition to the factors outlined in para 6, the
report highlighted a number of issues for further attention during
1997-98. Principal among these were:
- introduction of emergency admissions units-which allow
for acute assessment and, with rapid diagnostic support, the early
discharge of patients;
- length of stay-which requires further examination to
assess the impact of delayed discharges and the proportion of
older patients with multiple pathology;
- GP referral patterns-which indicate varying referral
rates, changes in referral thresholds, switches of referrals between
hospitals and the impact of Total Purchasing Projects and out-of-hours
schemes;
- definitions and reporting of closures to admissions-which
need to be consistent across all health authority areas; and
- staffing issues-including recruitment, junior doctors'
training, constant pressures, staff sickness and the distribution
of medical staff between trusts.
|
