Patient and GP factors associated with emergency medical admissions to one UK district general hospital

Objectives: Despite international debate over growing pressures on hospital beds, particularly from rises in emergency admissions, there are few published data on the characteristics of patients admitted to hospital. Most research has attempted to explore the appropriateness of general practitioner (GP) admissions, yet even the proportion of emergency admissions made via the GP is not known. This study aimed to investigate GP and patient factors associated with acute medical admissions to one hospital in Birmingham, UK. Methods: A study was performed on all acute medical admissions made over one week to a district general hospital in Birmingham and local general practices referring acutely to it. Admissions were identified from routine hospital dataset and the information validated. Factors perceived as linked to admission were explored by semi-structured interview or postal questionnaire with the admitting doctors and with a proportion of patients. The subjects were 158 patients and the 84 GPs involved in a proportion of the admissions. Outcome measures were admission routes, diagnoses, linked medical and social factors. Results: Only 84 (53%) patients were admitted via their GP (or deputy). 47% were self-referrals or admitted via outpatients. Data on 16% patients could not be validated because of GP refusal (3 doctors, 15 patients) or untraceable doctor (10 patients). Most admissions were for respiratory problems (47, 30%), mainly cases of infective illness (13% all admissions, 43% respiratory). Cardiovascular disease involved 16% cases, principally myocardial infarction or angina. Drug overdose was the most frequent single diagnosis, almost 1 in 10 acute admissions. 69% of the GP admissions were over 65 years old (30% over 75) against 36% of the non-GP (p