title: Comparison of attendance and emergency admission patterns at accident and emergency departments in and out of London.
abstract: OBJECTIVE
  To compare the sociodemographic characteristics, diagnoses, and mode of referral of people and emergency admissions between an accident and emergency department in inner London and one in a town outside London.
  
  
  METHODS
  Standardised questionnaire completed prospectively over two weeks by field-workers in each accident and emergency department.
  
  
  METHODS
  Accident and emergency departments in an inner London teaching hospital and an associated teaching hospital outside London.
  
  
  METHODS
  3039 adults newly attending the departments, 1476 in inner London and 1563 outside London.
  
  
  METHODS
  Sociodemographic characteristics, diagnosis, mode of referral, and whether the patient was admitted.
  
  
  RESULTS
  General practitioner referrals accounted for similar proportions of the adult attendances (12% in inner London, 15% outside London). People attending at the inner London department were more likely to be tourists or long distance commuters (12% (179/1476) v 6% (95/1563)), single (43% (643) v 32% (505)), to live alone (24% (360) v 14% (225)), to have moved recently (13% (194) v 7% (107)), or to be homeless (3.3% (48) v 0.6% (10)). Broad clinical groupings of patients were similar in both departments. 291 people were admitted in inner London and 284 outside London. The proportions admitted from each sociodemographic group were similar in the two hospitals.
  
  
  CONCLUSIONS
  Differences in sociodemographic characteristics were more important than general practice referral patterns in determining the differences in people attending at accident and emergency departments inside and outside London. Many of these characteristics are likely to be found in other inner city populations. A strategy to improve acute care in inner London should take account of the needs of these sociodemographically different groups.
authors.affiliation: Division of Community Health, United Medical School, London.
authors.forename: R F
authors.initials: RF
authors.lastname: Jankowski
authors.forename: S
authors.initials: S
authors.lastname: Mandalia
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England; D005194:Family Practice; D006801:Humans; D008131:London; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012924:Social Conditions; D011795:Surveys and Questionnaires