Audit of emergency medical admissions during the winter 1997/1998

To test the hypothesis that a significant cause of rising medical admissions over the Christmas and New Year period is the failure of social and medical systems which support patients at home for most of the year; and to understand the reasons for admission during the winter months of an at risk population and to identify possible avoidable admissions.

Structured interviews were conducted with patients within 48 hours of admission to collect information on home circumstances and contact with social, medical and primary care in the year prior to admission. In cases where the patient was unable to provide this information, case notes and nursing notes were reviewed. Discharge diagnosis was recorded at the end of the study period.

Five hundred and thirty nine patients defined as an "at risk group" who were admitted to hospital as emergency medical admissions between 1st December 1997 and 31st January 1998.

Subjects were predominantly female (58%). The major diagnostic groups were cardiac (27%) and respiratory (22%). Respondents indicated no change in primary care in the period preceding their admission, with the exception of day centre support. Sixty seven percent of patients fully interviewed received help from carers, friends or relatives with daily tasks and only seven (3%) reported receiving less input prior to admission. Forty five percent of these patients had seen a GP within the month prior to their admission.

The study results showed no breakdown in either social or family support. In the group interviewed, the proportion who had experienced any decrease in social support during the period prior to admission was very small.