A&E ATTENDANCES – NHS LOTHIAN

Sheila King

A&E Departments - Lothian

• RIE – approx 105,000 atts per annum

• St John’s – some 47,000 attendances

• RHSC (paediatric unit) – 36,000 atts

• Minor Injuries Unit at Western General Hospital site in north of city – 18,000 patients per annum

Trends in attendance – November to June

• November 08 to June 09 compared to Nov 07 to June 08

• RIE A&E up 3%• St John’s up 9%• RHSC up over 8%• WGH MIU only increased by 1%• Proceed to analyse 3 main sites over 4 months

March to June 2009

Referral source by site

%AGE OF ALL A&E ATTENDANCES ACCOUNTED FOR BY MAIN SOURCES OF REFERRAL

0%

10%

20%

30%

40%

50%

60%

70%

80%

999 Emergency Self referral GP NHS24

RIE

St John's

RHSC

Triage Category

%AGE OF ALL A&E ATTENDANCES ACCOUNTED FOR BY MAIN TRIAGE CATEGORIES

0%

10%

20%

30%

40%

50%

60%

70%

80%

Standard Urgent Very Urgent Imm Resus

RIE

St John's

RHSC

Arrival Mode

%AGE OF A&E ATTENDANCES ACCOUNTED FOR BY MAIN ARRIVAL MODES

0%

10%20%

30%

40%

50%60%

70%

80%

Private transport Emergencyambulance

Urgent ambulance(GP)

Public transport

RIE

St John's

RHSC

% age band – all 3 sites

PROPORTIONATE USAGE OF A&E BY AGE BAND

0

2

4

6

8

10

12

14

16

18

0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 Over 75

%of A&E

% of Lothian popl

% age admitted from A&E

Percentage of A&E attenders admitted by site

0%

5%

10%

15%

20%

25%

30%

RIE St John's RHSC All

% admitted by age bandPERCENTAGE OF A&E ATTENDERS ADMITTED

0%

10%

20%

30%

40%

50%

60%

70%

0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 Over75

RIE

St John's

RHSC

All

% age by arrival hour by site

%AGE OF A&E ATTENDANCES BY ARRIVAL HOUR

0

1

2

3

4

5

6

7

8

9

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

RIE

St John's

RHSC

% age discharges to “GP care – no further appointment”PERCENTAGE OF DISCHARGES FROM A&E TO

"GP CARE - NO FURTHER APPOINTMENT"

0%

10%

20%

30%

40%

50%

60%

70%

RIE St John's RHSC

Did Not Waits

• RIE and St John’s – a total of 1236 patients left without being seen in 4 months

• 736 (62%) left within 2 hours of arrival

• 25% of did not waits arrived by emergency ambulance

• 50% were in the age group 15 to 34

Conclusion

• 3 very different A&E departments• Disproportionate usage of A&E greatest among 0-4,

5-14, 15-24 and over 75 year olds • Admission from A&E increases markedly with age• Attendances by arrival hour – very obvious peak 6-

7pm RHSC, 6pm St John’s, late morning RIE• Surprising issues around “did not waits”, many leaving

within 2 hours, 25% arriving by emergency ambulance• Proceed to look to try to find some pointers around

increased activity, particularly evident on RHSC and St John’s sites

RHSC – March to June 09 vs March to June 08

• 7% increase in A&E attendances• Large increases in 999 emergency and GP sources

of referral• Age band 0-4 increased attendances by 27% (rising

birth rate but disproportionately high increase in A&E att) – all other age bands reduced

• Admissions from A&E down – both %age admission rate and overall number of admissions (despite 7% increase in A&E attendance

St John’s – March to June 09 vs March to June 08

• 5.5% increase in A&E attendances• Age band 0-4 increased attendance by 27%, 5-14

increased by 10%• Over 55% of increase accounted for by 0-14 year

olds at St John’s A&E• Admissions from A&E down – both %age admission

rate and overall number of admissions (despite increase in A&E attendance)

• Admission rates down by 17% in 0-14 age group and by 15% in 15-24 year old age group

RIE – March to June 09 vs March to June 08

• 3.7% increase in A&E attendances• 55% increase in 5-14 year old age group, 8%

increase in 15-24 age group and 7% in 65-74 age group

• Admission rate from A&E down v. slightly from 28.9% to 28.2% (in total number of admissions up 1.4%)

• Increase in number of admissions accounted for mainly by 65-74 age group, but also 15-24 age group.

CONCLUSION

• A&E attendance rates increasing in all 3 A&E departments (based on 4 months 2008/2009)

• Younger age groups large contributor to increased attendances

• Admission rates from A&E down on all 3 sites – RHSC and St John’s – number of admissions down despite increased A&E attendance

• RIE site – 65-74 age group accounts for 70% of increase in admissions (but only 14% of increase in attendances)