[Shortage in admission capacity for acute cases]

According to Poolman et al. (this issue), 6% of patients visiting the casualty department of a large Amsterdam hospital and requiring hospital admission had to be transported elsewhere at the expense of a considerable administrative effort on the part of the emergency-care physicians. Contributing factors are the way the hospital handles capacity problems, discharge procedures and personnel shortages, and, at the level of the city, the system used to allocate budget for acute care according to the relative needs of the hospitals. However, the major factor is the overall capacity problem in Dutch health care resulting from tight budget control. Despite intense discussions, major changes in this system have yet to be implemented. In the near future lack of qualified medical and nursing personnel will be the main factor that will need to be addressed urgently.