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)