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Increase in emergency A&E admissions caused by improved hospital survival rates, study reveals

Posted on 19 October 2017

Record survival rates from heart attacks and strokes are fuelling a rise in Accident & Emergency admissions, a major study involving the University of York has found.


Record survival rates from heart attacks and strokes are fuelling a rise in Accident & Emergency admissions. Credit: flickr.com/Lydia

Researchers discovered that those surviving life-threatening conditions such as heart attacks and strokes face a high risk of being readmitted as an emergency within a few years of originally falling ill.

According to the study, 37 per cent of the increase in emergency admissions and their cost can be explained by hospitals’ success in saving the lives of such patients.

The research, carried out at the University of York, City, University of London, Imperial College London and the University of Palermo, is the first to look at the impact of survival rates on future care. The study was funded by The Health Foundation and published in the journal of Health Services Research.

Survival rates

Research Fellow Dr Stephen Martin, of the University of York’s Department of Economics and Related Studies, said: “One reason for the continued upward trend in the number of emergency admissions is that hospitals are improving patient survival rates, particularly for acute life threatening conditions. 

“Frail patients who might previously have died are now surviving their initial hospital admission but are at risk of readmission following their discharge from hospital.”

The researchers recommend that increased support for those with acute conditions after their first admission may be an effective way to reduce A&E demand in the future and ease the strain on struggling NHS hospitals.

To determine the impact of survival rates on emergency admissions, the study looked at a large dataset including 10 million patients with a first hospital admission for an acute event, such as a heart attack or a stroke, between April 2000 and March 2010. They then followed these patients for up to two years from the first admission until 2012, counting the times they were back for an emergency admission for any reason and to any hospital.

Policy implications

The survival effect led to an estimated increase of 426,000 emergency admissions in 2012, remaining at this higher level thereafter, costing NHS hospital services around £1 billion every year. This estimate does not include the effect of further  improvements in survival which are likely to have occurred after 2009.

Dr Mauro Laudicella, Senior Lecturer in Health Economics in the School of Health Sciences at City, University of London, was the Principal Investigator on the study.

He said: “Our findings have important policy implications, as they show that the assumption that health care providers can directly control their flow of emergency admissions may be in part flawed. Indeed, current policies may generate unwanted consequences for the health system, by draining funding from high-performing hospitals that are particularly successful in saving their patients’ lives.

“As hospitals continue to improve their performance in survival rates, discharged patients may become increasingly frail and at high risk of accessing emergency care in the future. Therefore, the effect that we found is likely to be magnified in future years, especially for better performing hospitals with the highest survival rates. As a result, managing and supporting the health conditions of these patients after their hospital discharge could be key to reducing demand for emergency services in the future.”

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About this research

Dr Stephen Martin is a Research Fellow with the University of York’s Department of Economics and Related Studies. In collaboration with researchers from City, University of London, Imperial College London and the University of Palermo, he investigated the impact of survival rates on future care.

The results of the study, funded by The Health Foundation are published in the journal of Health Services Research.