Factors Influencing A & E Attendance, Admissions and Waiting Times at Two London Hospitals

Aims: To inform wider debate regard attendance at the Accident & Emergency department via analysis of the complex factors regulating attendances at two London hospitals.

Study Design: Analysis of 508,569 A&E attendances from a large hospital data base.

Place and Duration of Study: Attendances between 2013/14 and 2015/16 at Kings College hospital (Denmark Hill, inner London) and between 2014/15 and 2015/16 at Princess Royal hospital (Orpington, outer London).

Methodology: Analysis of attendances and time spent in A&E based on age, gender, presenting condition, frequency of re-attendance, distance from hospital, time of day, day-of-week, month of year and deprivation score.

Results: Only 59% of attendances were from persons whose home address was closest to either KCH or PRH, indicating immediate location rather than home address plays a huge role in access to an A&E (especially for London hospitals). Unwell adult was the most common presenting condition. Some 84% of persons presenting with stroke were admitted, and 56% of persons presenting with cardiac arrest died in A&E. Children in the first year of life had the highest number of attendances, but the proportion admitted increases with age. Attendances declined in an exponential manner with distance, although the decay rate varied between the two sites. Attendance rates increased with Index of Multiple Deprivation (IMD) score, and were 50% higher in the most deprived areas compared to the very least deprived. Number of attendances peak on Monday and Friday, but admission rate is lowest on the weekend. Persons commuting to London for work have higher weekday attendances, while tourists and visitors have higher weekend attendances. Attendances reach a minimum, while the proportion who die reaches a maximum, in the interval between 6 am to 7am, while the proportion admitted peaks between 5 am and 6 am. Some 49% of persons (average age of 36 years) did not re-attend, while the 0.41% who re-attended after 10 days had an average age of 45.5 years.

Conclusions: A&E attendance at any hospital is a complex expression of a whole system, of which access to primary care by local residents is only a part of the bigger picture.