title: Hospital characteristics affecting potentially avoidable emergency admissions: national ecological study.
abstract: Some emergency admissions can be avoided if acute exacerbations of health problems are managed by emergency and urgent care services without resorting to admission to a hospital bed. In England, these services include hospitals, emergency ambulance, and a range of primary and community services. The aim was to identify whether characteristics of hospitals affect potentially avoidable emergency admission rates. An age-sex adjusted rate of admission for 14 conditions rich in avoidable emergency admissions was calculated for 129 hospitals in England for 2008-2011. Twenty-two per cent (3,273,395/14,998,773) of emergency admissions were classed as potentially avoidable, with threefold variation between hospitals. Explanatory factors of this variation included those which hospital managers could not control (demand for hospital emergency departments) and those which they could control (supply in terms of numbers of acute beds in the hospital, and management of non-emergency and emergency patients within the hospital). Avoidable admission rates were higher for hospitals with higher emergency department attendance rates, higher numbers of acute beds per 1000 catchment population and higher conversion rates from emergency department attendance to admission. Hospital managers may be able to reduce avoidable emergency admissions by reducing supply of acute beds and conversion rates from emergency department attendance.
authors.affiliation: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK a.ocathain@sheffield.ac.uk.
authors.forename: A
authors.initials: A
authors.lastname: O'Cathain
authors.affiliation: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: E
authors.initials: E
authors.lastname: Knowles
authors.affiliation: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: R
authors.initials: R
authors.lastname: Maheswaran
authors.affiliation: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: J
authors.initials: J
authors.lastname: Turner
authors.affiliation: Sheffield Emergency Care Forum, Sheffield, UK.
authors.forename: E
authors.initials: E
authors.lastname: Hirst
authors.affiliation: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: S
authors.initials: S
authors.lastname: Goodacre
authors.affiliation: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: T
authors.initials: T
authors.lastname: Pearson
authors.affiliation: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: J
authors.initials: J
authors.lastname: Nicholl
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D006300:Health Services Misuse / Q000517:prevention & control / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data* / Q000600:supply & distribution; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D055815:Young Adult
keywords: access and evaluation; emergency treatment; health care quality; variation analysis