Key Health Data for the West Midlands 2001
Chapter 4: Accident and Emergency
List
of Tables
List
of Figures
Main Body
4: Accident and Emergency
8: Perinatal Mortality
9: Crime
10: Sports Facilities
11: Housing Quality
12: Inequalities, Focusing on the early years
4.1 Introduction
Patients attend A&E departments for a large variety of conditions, from a sprained ankle to a heart attack. The pressures on departments are increasing due to a general rise in new patient attendances of 2% per annum and a rise in acute medical emergency admissions for which there is often no hospital bed available. (BAEM, 1998)
Since computerisation of A&E departments it has been mandatory for them to collect a Minimum Data Set (MDS). This contains information on every attendance, such as date of birth, address, time arrived, type of accident, investigations, diagnoses and treatments.
The following analyses are based on information
from the MDS collected from 14 A&E Departments in the West Midlands
region between 1st April 2000 and 31st March 2001. The MDS contains information
on all attendances including follow-up attendances. However, the following
analyses are based on new attendances, as this is a more appropriate way
to compare different departments. The location of each department and
whether or not they are participating in the study is shown in Figure
4.1.
Data is collected by the West Midlands Accident
& Emergency Surveillance Centre based at the University of Birmingham
Kidderminster Hospital A&E department was participating in the project
until September 2000 when it became a Minor Injuries Unit. Attendances
at this department have not been included in the analyses.
 |
Figure 4.1. Location of A&E departments and participation status (whether or not submitting data) |
4.2. Attendance Rates
Figure 4.2 shows the combined attendance rates at all 14 A&E departments by PCT, along with the location of each department and whether or not they are submitting data to the surveillance centre. As can be seen attendance rates are highest in the Black Country, Stoke and Coventry, whilst rates are lowest in Shropshire
 |
Figure 4.2. A&E attendance rates per 10,000 population by PCT, location of A&E departments and participation status, 2000/2001 |
4.3. Demography
Figure 4.3 shows the age-sex specific attendance rates at the 14 A&E departments. As can be seen attendances by males are higher than females until the age of 70 when female attendances are higher. Peak attendance for males is in the 30-34 age group and for females in the over 85s.
 |
Figure 4.3. Age-sex specific A&E attendance rates, 2000/200100/2001 |
4.4. Temporal Trends
Hour of Attendance
Figure
4.4 shows the hour of attendance at A&E, as recorded when registering
in the department. Peak attendance is between 11:00 and 11:59 (7.1% of
attendances), with another peak in the early evening between 18:00 and
18:59 (6.3% of attendances). Attendances decrease after the second peak
and remain low throughout the night. The lowest attendance is between
05:00 and 05:59 (0.8%).
 |
Figure 4.4. A&E attendance by hour, 2000/2001 |
4.5. Day of Attendance
When looking at A&E attendance by day, Mondays have the highest proportion of attendances with 15.7%. Saturdays have the lowest proportion of attendances (13.7%).
 |
Figure 4.5. A&E attendance by day, 2000/2001 |
4.6. Reason for Attendance
In the MDS attendances are classified as one of seven categories. Figure 4.6 uses data from 11 Trusts and shows the proportions of attendances in each category. 'Other Non-accident' accounted for the highest proportion of attendances. This group consists mainly of medical emergencies. Accidents accounted for 42.3% of attendances at A&E.
 |
Figure 4.6. Reason for attending A&E, 2000/2001 |
4.7. Arrival Mode
In the MDS mode of arrival to the A&E department is recorded as by 'Ambulance' or 'Other'. Figure 4.7 shows the percentage of patients arriving at A&E in an ambulance by age group. There are large variations between the different age groups, with 9.4% of the under 15s and 72.6% of the over 75s arriving by ambulance.
 |
Figure 4.7. Arrival Mode |
4.8. Disposal
Figure
4.8 shows the variation between A&E departments in the proportions
of attenders that are admitted to a hospital bed. In general it appears
that departments in urban areas admit a higher percentage of patients
than those in rural areas, with Heartlands, Burton and City Hospitals
admitting the most, and Alexandra, Hereford and Princess Royal Hospitals
admitting the least patients. Reasons for these differences may include
the demographic structure of the surrounding area and the levels of deprivation.
 |
Figure 4.8. Percentage of A&E attendees admitted to hospital, 2000/2001 |
4.9. Ambulance Admissions
When looking at the numbers of patients arriving by ambulance there is great variation between the Trusts with Heartlands Hospital admitting nearly double the percentage admitted at Alexandra Hospital. The MDS does not include the type of ambulance call out, such as whether it was an emergency or a scheduled pick-up. This may be one reason for the variations, along with the differences in ambulance use by age as shown in Figure 4.7.
 |
Figure 4.9. Percentage of ambulance patients admitted to hospital, 2000/2001 |
References
1. British Association for Accident and Emergency
Medicine. The Way Ahead. London: BAEM, 1998
For more information please
contact Carol Richards on
0121 414 3368
© Department of Public Health
and Epidemiology, University of Birmingham