Data from: Risk factors for admission at three urban emergency departments in England: a cross-sectional analysis of attendances over 1 month

Objective: to investigate factors associated with unscheduled admission
following presentation to Emergency Departments (EDs) at three hospitals
in England. Design and setting: cross-sectional analysis of attendance
data for patients from three urban EDs in England: a large teaching
hospital and major trauma centre (Site 1), and two district general
hospitals (Sites 2 and 3). Variables included: patient age, gender,
ethnicity, deprivation score, arrival date and time, arrival by ambulance
or otherwise, a variety of ED workload measures, inpatient bed occupancy
rates and admission outcome. Coding inconsistencies in routine ED data
used for this study meant that diagnosis could not be included. Outcome
measure: The primary outcome for the study was unscheduled admission.
Participants: all adults aged 16 and over attending the three inner London
EDs in December 2013. Data on 19,734 unique patient attendances were
gathered. Results: outcome data were available for 19,721 attendances
(>99%), of whom 6,263 (32%) were admitted to hospital. Site 1 was
set as the baseline site for analysis of admission risk. Risk of admission
was significantly greater at Sites 2 and 3 (AOR relative to Site 1 for
Site 2 was 1.89, 95% CI 1.74-2.05, p<0.001), and for patients of
black or black British ethnicity (1.29, 1.16-1.44, p<0.001).
Deprivation was strongly associated with admission. Analysis of
departmental and hospital-wide workload pressures gave conflicting
results, but proximity to the “four-hour target” (a rule that limits
patient stays in EDs to four hours in the NHS in England) emerged as a
strong driver for admission in this analysis (3.61, 3.30-3.95,
p<0.001). Conclusion: this study found statistically significant
variations in odds of admission between hospital sites when adjusting for
various patient demographic and presentation factors, suggesting important
variations in ED- and clinician-level behaviour relating to admission
decisions. The four-hour target is a strong driver for emergency
admission.