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> *From:* Jonathan Benger <[log in to unmask]> > *To:* [log in to unmask] > *Date:* Tue, 17 Jan 2006 00:20:21 -0000 > > This thread has cropped up at a most fortuitous time. I am currently in > the > process of analysing data from recently completed research that may > suggest > answers to some of Maurice's questions. This was undertaken to shed > light on > issues that have arisen during discussions between our emergency > department > and the local primary care trust in relation to emergency admissions and > primary care access. Indeed, it might well be helpful to reference some > of > the list's observations (particularly the figures given by Ray and > Mark) in > the final manuscript for publication, if you are willing to grant your > permissions to do so. > > My own view is that there is a distinct shift from GP referred to direct > admissions, and that there are several factors at work. These include > changes in behaviour and perception in both primary care and patients > accessing the service as well as the underlying demographic trends and > "success" of modern medicine. This leads me on to a related question. > Here > in Bristol a lot of figures are circulating regarding the impact of > various > community-based admission avoidance schemes, but the evidence to support > these seems somewhat sparse. Does anybody have a local scheme (emergency > care practitioners, intermediate care beds, community matrons, etc.) > that > has led to a clear reduction in emergency admission to hospital (as > opposed > to a slowing of year-on-year growth)? I am interested in identifying > what > has actually worked in real clinical practice in the UK, and any success > stories you are able to relate. > > Thanks in advance for any help, comments, suggestions, etc. > > Jonathan Benger. > > Please feel free to contact me off list if preferred: > [log in to unmask] We underwent a reconfiguration, with one of our two units taking no emergency surgery or significant trauma in June 05. We expected the numbers to fall overall. In fact 2005 was busier than 2004 at both sites, to our considerable surprise. The bigger site was 9.7% busier and the smaller site 3% busier. Overall, we were just over 7% busier. The number of admissions has also increased, with a dramatic spike in admissions from November onwards. This is despite the introduction and then expansion of intermediate care and community beds, rapid response teams, night nursing teams and expansion of the community iv team. In short, none seems to have had any impact. /Rowley./