In a paper published in the Journal of the Royal Society of Medicine, a team from Imperial College London examined time trends in emergency hospital admissions via accident and emergency departments in England. The proportion of emergency hospital admissions in which patients were admitted via an A and;E department increased markedly in England between 2001–2002 and 2010–2011.
There are several possible explanations for this trend. These include coding changes and the greater use of A and E departments to assess patients before they are admitted as emergencies. Changes in access to general practitioners – both during normal working hours and out of hours – may also have contributed to these changes.
The findings of the study in the JRSM are similar to those from studies in the United States. Future health policy should address gatekeeping in A and E departments and the provision of urgent care in general practice New models of care such as urgent care services that employ GPs in A and E departments as the gatekeepers to specialist urgent care may help in addressing this challenge but must be evaluated before they are scaled up.