There are considerable misconceptions about emergency admissions. Some have claimed that they follow roughly the same pattern every year, i.e. implying precision or certainty. However the link between the weather (temperature, air pressure, humidity, etc) and environment (air quality, viral & other infectious outbreaks) creates the opportunity for emergency admissions to show highly erratic trends over time, i.e. while there may be general seasonal and day of week patterns the upper and lower limits around the average are widely spaced.
The financial risk associated with emergency admissions is up to 3-times higher than due to chance variation alone. There are considerable implications to the longer-term bed requirements of hospitals, to health care costs, commissioning and financial risk in GP commissioning. These issues are covered in the 'Hospital Beds' and 'Financial Risk' folders respectively.
HCAF has discovered that the trend to higher than expected medical admissions, which has been ongoing for the last 40 to 50 years, is made up from a repeating pattern of step-like increases occurring at three to eight year intervals. It is these steps rather than the trend between the steps which is contributing (along with technological change) to higher than expected growth and patterns in the total costs of health care. These step increases appear to occur in a manner expected of an infectious spread and are most apparent using small area data. In England, the 2002 and 2007 'outbreaks', which occurred in the last quarter of the financial year, appears to be linked to 8,000 excess deaths in 2003 and 2008. A further outbreak in early 2012 lead to a period of higher deaths which did not abate until mid-2013. Details of this research can be found in the paper dealing with end-of-life costs in the 'Financial Risk' page and additional papers listed below.
Other long-term cycles appear to apply for trauma admissions (mostly weather-related) and the economic cycle influences psychological and general health and leads to counter-cyclic changes in the mortality rate. It is becoming increasingly clear that health care costs behave in ways that simple demographic forecasts can never predict. These findings are of immense practical significance and greatly affect the pattern of costs over time (see 'Financial Risk' page).
Emergency Admissions Series
British Journal of Healthcare Management (BJHCM)
British Journal of Medicine and Medical Research (BJMMR)
Jones R (1997) Emergency admissions: Admissions of difficulty.
Health Service Journal 107(5546): 28-31 Read Me
Jones R (2009) Trends in emergency admissions. BJHCM 15(4): 188-196 Read Me
Jones R (2009) Cycles in emergency admissions. BJHCM 15(5): 239-246 Read Me
Jones R (2009) Emergency admissions and hospital beds. BJHCM 15(6): 289-96 Read Me
Jones R (2009) Emergency admissions and financial risk. BJHCM 15(7): 344-350 Read Me
Jones R (2010) Cyclic factors behind NHS deficits and surpluses.
BJHCM 16(1): 48-50 Read
Jones R (2010) Emergency preparedness. BJHCM 16(2): 94-95 Read Me
Jones R (2010) Unexpected, periodic, increase in medical inpatient care: Man-made or
new disease? Medical Hypotheses 74(6): 978-983 Read Me
Jones R (2010) Can time-related patterns in diagnosis for hospital admissions help identify
common root causes for disease expression? Medical Hypotheses 75(2): 148-54 Preview
Jones R (2010) The case for recurring outbreaks of a new type of infectious disease
across all parts of the United Kingdom. Medical Hypotheses 75(5): 452-457 Preview
Jones R (2010) The nature of health care costs and financial risk in commissioning.
BJHCM 16(9): 424-430 Read Me
Jones R (2010) Forecasting emergency department attendances.
BJHCM16(10): 495-496 Read Me
Jones R (2010) Trends in programme budget expenditure.
BJHCM 16(11): 518-526. Read Me
Jones R (2010) Gender ratio and hospital admissions. BJHCM 16(11): 541 Read Me
Jones R (2010) A fair tariff for emergency assessment activities - lessons learned.
BJHCM 16(12): 574-583 Read Me
Jones R (2011) Impact of the accident and emergency target in England.
BJHCM 17(1): 16-22 Read
Jones (2011) Infectious outbreaks and the NHS Capitation Formula.
BJHCM 17(1): 36-38 Read Me
Jones R (2011) Costs of paediatric assessment. BJHCM 17(2): 57-63 Read Me
Jones R (2011) Cycles in inpatient waiting time. BJHCM 17(2): 80-81 Read Me
Jones R (2011) Cycles in gender-related costs for long-term conditions.
BJHCM 17(3): 124-125 Read Me
Jones R (2011) CMV and health care costs. BJHCM 17(4): 168-169 Read Me
Jones R (2011) Unanswered questions from the trends in international bed occupancy.
BJHCM 17(7): 307-313 Read Me
Jones R (2011) Volatility in bed occupancy for emergency admissions.
BJHCM 17(9): 424-430. Read Me
Jones R (2012) Time to re-evaluate financial risk in GP commissioning.
BJHCM 18(1): 39-48 Read Me
Jones R (2012) Gender ratio and cycles in population health costs.
BJHCM 18(3): 164-165. Read Me
Jones R (2012) Are there cycles in outpatient costs? BJHCM 18(5): 276-277. Read Me
Jones R (2012) Increases in GP referral: jump or infectious push?
BJHCM 18(9): 488-497 Read Me
Jones R (2012) Age-related changes in A&E attendance.
BJHCM 18(9): 508-509. Read Me
Jones R (2012) Diagnoses, deaths and infectious outbreaks.
BJHCM 18(10): 539-548. Read Me
Jones R (2012) Excess deaths following a procedure in 2008.
BJHCM 18(10): 554-555. Read Me
Jones R (2013) Could cytomegalovirus be causing widespread outbreaks of chronic poor
health? In: Hypotheses in Clinical Medicine, pp 37-79, Eds Shoja M, et al.
Nova Science Publishers Read-only Full Text
Jones R (2013) An unexplained increase in deaths in England and Wales during 2012.
BJHCM 19(5): 248-253. Read Me
Jones R (2013) Trends in unscheduled care. BJHCM 19(6): 301-302, 304. Read Me
Jones R (2013) Hidden complexity in A&E attendances in England.
BJHCM 19(7) : 354-355. Read Me
Jones R (2013) Is the demographic shift the real problem? BJHCM 19(10): 509-511 Read
Jones R (2013) Widespread outbreaks of a subtle condition leading to death and
hospitalisation. Epidemiology: Open Access 3(4): 1000137 Read
Jones R (2013) Trends in elderly diagnoses: links with multi-morbidity.
BJHCM 19(11): 553-558. Read
Jones R (2013) A lagged cycle in cancer emergency admissions.
BJHCM 19(12): 606-607. Read Me
Jones R (2013) Analysing excess winter mortality. BJHCM 19(12): 601-605. Read
Jones R (2013) Do recurring outbreaks of a type of infectious immune impairment trigger
cyclic changes in the gender ratio at birth? Biomedicine International 4(1): 26-39. Read
Jones R (2013) A recurring series of infectious-like events leading to excess deaths
and medical admissions in Scotland. Biomedicine International 4(2): 72-86. Read
Jones R (2014) Increased deaths in 2012: which conditions? BJHCM 20(1): 45-47. Read
Jones R (2014) Forecasting conundrum: a disease time cascade. BJHCM 20(2): 90-91. Read
Jones R (2014) What is happening in unscheduled care?
Journal of Paramedic Practice 6(2): 66-68. Read
Jones R (2014) Unexpected changes in outpatient first attendance.
BJHCM 20(3): 142-143. Read
Jones R (2014) Long term cycles in admissions for neurological conditions.
BJHCM 20(4): 192-193. Read
Jones R (2014) Unexpected single year of age changes in the elderly mortality rate in England & Wales
during 2012.British Journal of Medicine and Medical Research 4(16): 3196-3207. Read
Jones R (2014) Infectious-like spread of an agent leading to increased medical hospital
admission in England. Biomedicine International 5(1): in press Read
Jones R (2014) Untangling the A&E crisis. BJHCM 20(5): 246-247. Read
Jones (2014) Unexpected and unexplained increase in death due to neurological disorders in 2012 in
England & Wales: Is cytomegalovirus implicated? Medical Hypotheses 83(1): 25-31. Read, Extract
Jones R (2014) Trends in death and end-of-life costs in the UK. BJHCM 20(6):298-299. Read
Jones R (2014) Infectious-like spread of an agent leading to increased medical admissions and deaths in
Wigan (England), during 2011 and 2012. BJMMR 4(28): 4723-4741. Read
Jones R (2014) Trends in admissions for allergy. BJHCM 20(7): 350-351. Read
Jones R (2014) A study of an unexplained and large increase in respiratory deaths in England and Wales:
Is the pattern of diagnoses consistent with the potential involvement of cytomegalovirus?
BJMMR 4(33): 5179-5192. Read
Jones R (2015) A new type of infectious outbreak? SMU Medical Journal 2(1): 19-25. Read
Jones R (2015) An unexpected increase in adult appendicitis in England (2000/01 to 2012/13): Could
cytomegalovirus (CMV) be a factor? BJMMR 5(5): 579-603. Read
Jones R (2015) A previously uncharacterised infectious-like event leading to spatial spread of deaths
across England and Wales: Characteristics of the most recent event and a time series for past events.
BJMMR 5(11): 1361-1380. Read
Jones R (2015) Roles for cytomegalovirus in infection, inflammation and autoimmunity.
In Infection and Autoimmunity. 2nd Edition, Eds NR Rose, Y Shoenfeld, N Agmon-Levin,
Elsevier: Amsterdam, Chapter 18, in press.
Jones R, Beauchant S (2015) Small area spread of a new type of infectious condition across Berkshire
in England between June 2011 and March 2013: Effect on medical emergency admissions.
BJMMR 6(1): 126-148. Read Me
Jones R (2015) Unexpected and disruptive changes in admissions associated with an infectious-like
event experienced at a hospital in Berkshire, England around May of 2012.
BJMMR 6(1): 56-76. Read Me
Jones R (2015) Unexplained infectious events leading to deaths and medical admissions.
BJHCM 21(1): 46-47. Read Me
Jones R (2015) Recurring outbreaks of an infection apparently targeting immune function, and
consequent unprecedented growth in medical admission and costs in the United Kingdom:
A review. BJMMR 6(8): 735-770. Read Me
Jones R (2015) Forecasting medical emergency admissions. BJHCM 21(2): 98-99. Read Me
Jones R (2015) Why is it so difficult to accurately forecast medical costs? BJHCM 21(3): in press. Read
Jones R (2015) Has the UK experienced a four-in-a-row epidemic? BJHCM 21: in review Read
Jones R (2015) A regular series of unexpected increases in total deaths for residents of Scottish Local
Authority areas: Is an infectious source implicated? Biomedicine International (submitted) Read
Jones R (2015) Unexpected growth in deaths from Alzheimer's and dementia and other neurological
disorders in England and Wales during 2012 and 2013.
Journal of Neuroinfectious Diseases (in revision) Read
Jones R (2015) A time series of deaths in New Zealand - are hidden epidemics concealed in the trends?
in preparation Read
Jones R (2015) A time series of infectious-like events in Australia leading to increased deaths and medical
admissions. in preparation Read
Jones R (2015) The rise in medical admissions, a "wicked problem" with additional complexity arising
from periods of unexplained higher deaths. in preparation Read