Problems of Emergency Admissions to London Hospitals

Difficulty in admitting or failure to admit patients considered to be in urgent need of care and treatment in hospital are frustrating experiences for general practitioners and disquietening and perplexing ones for patients and their relatives. Such episodes are likely to undermine confidence in the organization and administration of the health services. They are, therefore, worthy of detailed study. Previous surveys have shown that delay in hospital admissions is a common complaint among general practitioners (Cartwright, 1964; Cartwright and Marshall, 1965) and that difficulty of admission has been associated particularly with older patients (Gibson, Hughes, and Broughton, 1958) and with maternity cases in London. This last problem has been eased by administrative changes introduced during 1964 (Ministry of Health, 1965) and is not considered in this paper. The study described in this paper followed up all those patients who had been referred with an urgent request for hospital admission to the Emergency Bed Service (EBS) in London during a period of 12 months, but for whom no arrangement could be made for admission at the time of the referral. By comparing this group of patients with groups who were admitted at the time of referral, the influence of age, sex, diagnosis, location, and other factors on the probability of successful emergency admission has been examined. On the basis of the data obtained, suggestions are made about the organization of domiciliary and hospital services.