Accident and Emergency Attendance and Admission

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Introduction

Attendance at Accident and Emergency is often a stressful event for individuals, and also a high profile element of NHS performance.  These pages show some analysis undertaken of attendance and admission at A&E by age in Somerset to help understand patterns.

Attendance

The likelihood of someone attending the Accident and Emergency (A&E) department of an acute hospital is related to their age, as shown in the figure below.  This graph shows the pattern by age and gender of the 175,000 attendances in 2015 of patients who are registered with a Somerset GP at any trust It should be noted that the rates (shown by the line) below simply divide the number of attendances by the number of people in each age cohort, and that some people will attend several times during the period.   The attendance rate is high for the under 5s, which reflects both the vulnerability of infants and the natural concern of parents.  The next peak is in the early 20s, when young adults may engage in risky behaviour such as sport or binge drinking.  It is also widely suggested that many young people attend A&E more readily than making an appointment to see their GP, for instance.  Attendance rates decline from this peak until the late 60s, after which rates rise to reach their highest levels of about 600/thousand population/year in the over 90s.   There are, of course, different numbers of Somerset people in each of these age groups, so the numbers (shown by the columns) of people attending in each of these age bands shows a different pattern, with, in broad terms, a decline in attendance by age.

Accident and Emergency Attendance by Age

Admission

About a third of attendances at A&E result in the patient being admitted to hospital.  Whilst the rates of admission (shown in the graph by the lines) show some similarity to attendances, with relatively high rates for infants followed by a trough until about the late sixties and a steady rise thereafter, there are significant differences.  The higher rate for female admission from the mid-20s to mid-40s is related to pregnancy.  It is also clear that a far higher proportion of older people are admitted than the young (except infants).  More than a quarter of all admissions were for people aged 80 or over. 

Emergency Admissions by Age

Trends in Emergency Admissions

Given the strong relationship with age – and the growth and ageing of the Somerset population - it is unsurprising that the number of emergency admissions has shown a steady rise over recent years.   In 2009/10 there were fewer than 50,000; by 2014/15 the number had reached almost 58,000, as shown in the graph.

The number of attendances is projected to rise in coming years, with more than 220,000 likely in 2035 if current demographic trends continue.  It is suggested that recent rises in attendances have been faster than demographics alone would suggest: although not quantified, it is possible that the rate will rise faster because of other social factors, including greater propensity for young people to attend A&E, the rise in multimorbidity and greater pressure on other public services such as social care.

Projected demand for Accident and Emergency

Implications for commissioning

Increased numbers of people attending A&E are likely to result from the growth and ageing of the population in Somerset, and this will be a strategic challenge to health services in the county.