A significant unresolved issue in the literature is that no satisfactory definition exists of what constitutes an emergency admission. Although most studies have used an administrative definition (namely a patient spending a defined period of time in a hospital), this definition should also require some consideration of the patient's clinical state (that is, they should have an emergency condition that requires urgent care) or else the potential will always exist for classification bias in the research literature.
Any focus on reducing hospital admissions largely considers the effectiveness of interventions to prevent exacerbations of chronic disease and does not consider the potential importance of preventing the development of these diseases.
Acute medical admissions for children have significant differences to adults: children are usually admitted on the initiative of a care-giver for a single, acute condition.
General practitioners (GPs), followed by the emergency department (ED), are the most important gatekeepers in the admission pathway for both adults and children in New Zealand. Therefore, interventions aimed at either GPs or EDs may have the largest potential to reduce the number of acute medical admissions.
A large number of steps, involving a wide range of health professionals, are involved in hospital admission. The presence of a range of steps and health professionals in the process indicates there is a wide range of possible interventions that could impact on the rising number of acute medical admissions.
The consequences of increased numbers of acute admissions include: a fiscal challenge to the budgets of the purchasers and the providers of secondary care services, a reduced ability to undertake non-urgent work, increased pressure on staff and difficulties with planning staffing levels. Finally, an increased workload for hospital staff may lead to changes in professional roles and have implications for professional education.
No published review has yet examined the rise in admissions with regard to its implications for the health of a population. For example, more admissions may represent an improvement in health outcomes associated with better access to secondary care services for some groups. Conversely, it may represent a deterioration in population health, reflecting lost opportunities to utilise other health interventions.
