Objective The number of emergency admissions to hospital in England and Wales has risen sharply in recent years and is a matter of concern to clinicians, policy makers and patients alike. However, the factors that influence this decision are poorly understood. We aimed to ascertain how non-clinical factors can affect hospital admission rates.
Method We conducted semistructured interviews with 21 participants from three acute hospital trusts. Participants included 11 emergency department (ED) doctors, 3 ED nurses, 3 managers and 4 inpatient doctors. A range of seniority was represented among these roles. Interview questions were developed from key themes identified in a theoretical framework developed by the authors to explain admission decision-making. Interviews were recorded, transcribed and analysed by two independent researchers using framework analysis.
Findings Departmental factors such as busyness, time of day and levels of senior support were identified as non-clinical influences on a decision to admit rather than discharge patients. The 4-hour waiting time target, while overall seen as positive, was described as influencing decisions around patient admission, independent of clinical need. Factors external to the hospital such as a patient’s social support and community follow-up were universally considered powerful influences on admission. Lastly, the culture within the ED was described as having a strong influence (either negatively or positively) on the decision to admit patients.
Conclusion Multiple factors were identified which go some way to explaining marked variation in admission rates observed between different EDs. Many of these factors require further inquiry through quantitative research in order to understand their influence further.
- Emergency Department
- Emergency Admission
- Unscheduled Admission
- Emergency Service
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Contributors IP, DM and TH came up with initial idea for the study. IP and DM developed the questionnaires. IP recruited and carried out the interviews. IP, HB, DM and SAI transcribed and analysed the interviews. IP, HB and SAI drafted and revised the manuscript with input from DM and TH.
Competing interests SAI, IP, DM and TH have support from Barts Health NHS Trust for the submitted work. Other authors have no competing interest to declare.
Ethics approval Queen Mary University of London Research Ethics Committee and the Barts Health Research and Development Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Extra data can be accessed via the Dryad data repository at the doi:10.5061/dryad.5m2c3.
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