Potentially preventable emergency admissions

We use Hospital Episode Statistics data to look at potentially preventable emergency admissions to hospital.

Indicator

Last updated: 29/06/2022

Effective clinical care
Primary and community care Hospital care Emergency care Integrated care International

Background

Emergency admissions, where patients are admitted to hospital urgently and unexpectedly (i.e. the admission is unplanned), are both costly and frequently unpleasant experiences for patients. Many hospital admissions related to long-term conditions could potentially be avoided with timely and effective community care. These conditions are known as ambulatory care sensitive (ACS) and urgent care sensitive (UCS) conditions. Here we look at emergency admission rates for these conditions in England, as well as emergency admission rates internationally for three common chronic conditions: chronic obstructive pulmonary disease (COPD), asthma and diabetes.

Key definitions:

Ambulatory care sensitive (ACS) conditions are conditions where effective community care and person-centred care can help prevent the need for hospital admission.

Urgent care sensitive (UCS) conditions are acute exacerbations of urgent conditions that a care system should treat and manage close to home and without the need for hospital admission in as many cases as possible. Although some of these admissions are necessary, a high rate may indicate avoidable admissions.


How have rates of emergency admissions for cases that can be managed outside hospital changed over time? 29/06/2022

Chart QualityWatch

Source:  

Hospital Episode Statistics data (years 2008/09 to 2020/21) Copyright © 2022, re-used with the permission of NHS Digital. All rights reserved.

Office for National Statistics, Population estimates 

NHS England, A&E Attendances and Emergency Admissions

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Between 2011/12 and 2019/20, the number of emergency admissions for ACS conditions and UCS conditions increased by 21% and 10% respectively (data not shown). However, rates of emergency admissions for these conditions remained relatively stable over the same time period. This is arguably a good result given that the total number of emergency admissions to hospital has risen over time, increasing by 25% between 2011/12 and 2019/20.

Data for 2020/21 shows a decrease in emergency admissions for ACS conditions and UCS conditions. Compared with 2019/20, the number of emergency admissions for ACS conditions fell by 24% and emergency admissions for urgent care sensitive conditions fell by 17% (data not shown). However, this came alongside a 16% fall in total emergency admissions during the coronavirus (Covid-19) pandemic, making it difficult to draw conclusions about the quality of care.

Nevertheless, seven in every 1,000 people in England were admitted to hospital in an emergency for an ACS condition in 2020/21, and 20 in every 1,000 people were admitted in an emergency for an UCS condition.


How has the number of emergency admissions for different ambulatory care sensitive conditions changed? 29/06/2022

Chart QualityWatch

Source:  

Hospital Episode Statistics data (years 2008/09 to 2020/21) Copyright © 2022, re-used with the permission of NHS Digital. All rights reserved. 

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This chart shows the percentage change in emergency admissions for specific ambulatory care conditions compared with the equivalent month in 2018/19 (April 2018 to March 2019). For example, there were 4% more emergency admissions for heart failure in January 2020 than in January 2019. 

Between April 2019 and February 2020, there was a moderate change in admissions for different conditions compared with 2018/19, ranging from a 32% increase in admissions for hypertension (high blood pressure) in July 2019 to a 13% decrease in admissions for chronic heart disease in December 2019. 

Between February 2020 and April 2020, the initial months of the Covid-19 pandemic, there was a 52% drop in emergency admissions for all listed ambulatory care sensitive conditions and a 36% drop in total emergency admissions (not shown). Since then, the change in emergency admissions for different ACS conditions from 2018/19 has varied to a much greater extent than before the pandemic. Conditions such as asthma and COPD have seen a marked decrease in emergency admissions, whereas emergency admissions related to hypertension and blood anaemia have increased. In February 2022, the biggest changes in emergency admissions were for hypertension (33% increase) and COPD (56% decrease).

For more information about ambulatory care sensitive (ACS) conditions, please see the About this data section of this page. 


How have rates of emergency admissions for specific urgent care sensitive conditions changed over time? 29/06/2022

Chart QualityWatch

Source:  

Hospital Episode Statistics data (years 2008/09 to 2020/21) Copyright © 2022, re-used with the permission of NHS Digital. All rights reserved. 

Office for National Statistics, Population estimates

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Overall, rates of emergency admissions are highest for falls, non-specific chest pain, and non-specific abdominal pain, but individual urgent care sensitive conditions have exhibited different trends over time. Between 2008/09 and 2019/20, the rate of emergency admissions increased for falls, cellulitis (not pictured), urinary tract infections, COPD and acute mental health crisis, but decreased for angina and non-specific chest pain. The rate of emergency admissions remained relatively steady for the other urgent care sensitive conditions. The drop in emergency admissions for falls in 2012/13 relates to changes in clinical coding, and the decrease in urinary tract infection admissions in 2017/18 is linked to improved coding of sepsis.

In 2020/21, the emergency admission rate fell slightly for all conditions except deep vein thrombosis and angina, where rates remained constant. The largest decrease was for COPD, which fell from 23 emergency admissions per 1,000 people in 2019/20 to 12 per 1,000 people in 2020/21.

For more information about urgent care sensitive (UCS) conditions, please see the About this data section. 


How does the rate of COPD hospital admissions compare internationally over time? 29/06/2022

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How does the rate of asthma admissions compare internationally over time? 29/06/2022

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Chronic obstructive pulmonary disease (COPD) and asthma are a group of common lung diseases that can make breathing difficult. Overall, hospital admission rates are higher for COPD than for asthma or diabetes-related conditions. In the UK, the age-sex standardised COPD hospital admission rate is around the average of the other Organisation for Economic Co-operation and Development (OECD) countries, and the hospital admission rate for asthma was the highest of all the comparator countries in 2019.

However, hospital admission rates for COPD and asthma have been reducing over time and there was a marked decrease for both conditions since the Covid-19 pandemic. For COPD, there was a reduction from 251 admissions per 100,000 population in 2006 to 115 admissions per 100,000 population in 2020. For asthma, the rate dropped from 79 admissions per 100,000 population in 2006 to 34 admissions per 100,000 population in 2020. This decrease may reflect some improvement in the quality of care provided for these conditions.

Time trends for the other countries presented here vary considerably. For example, there has been a continuous decrease in hospital admission rates for COPD and asthma in Italy and Finland, but admission rates for these conditions in Germany and the Netherlands have been increasing. Japan has the lowest hospital admission rate for COPD and Italy has the lowest rate for asthma.

The Taskforce for Lung Health’s five-year plan highlights that avoidable hospital admissions can be prevented through the effective implementation of evidence-based interventions for COPD and asthma, such as pulmonary rehabilitation and new technology, including smart inhalers. 

Time trends for the other countries presented here vary considerably. For example, there has been a continuous decrease in hospital admission rates for COPD and asthma in Italy and Finland, but admission rates for these conditions in Germany and the Netherlands have been increasing. Japan has the lowest hospital admission rate for COPD and Italy has the lowest rate for asthma.

The Taskforce for Lung Health’s five-year plan states that there has been little or no improvement in outcomes for people with lung disease in the UK for more than ten years, while other countries have made significant progress. The report highlights that avoidable hospital admissions can be prevented through the effective implementation of evidence-based interventions for COPD and asthma, such as pulmonary rehabilitation and new technology, including smart inhalers.


How does the rate of diabetes admissions compare internationally over time? 29/06/2022

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Diabetes is a common chronic condition for which inadequate management can lead to a range of short-term (e.g. diabetic coma) and long-term (e.g. cardiovascular disease, retinopathy and kidney disease) complications. The hospital admission rate for diabetes in the UK has remained relatively constant over time.

Italy, Spain, Sweden, Portugal and the Netherlands have lower hospital admission rates for diabetes compared with the UK, with Italy having the lowest rate in 2019 (41 admissions per 100,000 population). Despite having lower hospital admissions, the estimated prevalence of diabetes in 2017 was higher in Italy (4.8%), Spain (7.2%), Portugal (9.9%) and the Netherlands (5.3%) than in the UK (4.3%).

Whilst hospital admission rates have been stable in the UK, many adults and children still do not receive the recommended care processes for diabetes. There are also large variations across Europe in the quality of care provided and diabetes outcomes (see SWEET project).


How does the rate of diabetes lower extremity amputation admissions compare internationally over time? 25/06/2020

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Looking more specifically at hospital admission rates for diabetes lower extremity amputations, these have also remained stable over time in the UK, at 3 admissions per 100,000 population in 2017. The rate has also been stable in most other OECD countries. The rate in the UK is the lowest of all the comparator countries apart from Italy, at 1.6 amputations per 100,000 population in 2017. Many amputations may be prevented with targeted preventative services and fast access to high-quality foot care. The NHS Long Term Plan announced that in future, all hospitals should provide access to multidisciplinary foot care teams for patients who need secondary care support.

It is important to be mindful of the differences in coding practices (e.g. major/minor amputations) that are likely to have an impact on the observed differences between countries. OECD and country experts are working to further improve the quality of the diabetes data.


About this data

These indicators use data from Hospital Episode Statistics (HES) and the Organisation for Economic Co-operation and Development (OECD). The HES indicators were calculated according to NHS Digital's CCG Outcomes Indicatorspecifications. The defined list of ambulatory care sensitive conditions and urgent care sensitive conditions are as follows:

  • Ambulatory care sensitive conditions: chronic viral hepatitis B, diabetes mellitus, sideropenic dysphagia, anaemia, dementia, epilepsy, hypertension, angina pectoris, chronic ischaemic heart disease, heart failure, atrial fibrillation, pulmonary oedema, bronchitis, emphysema, chronic obstructive pulmonary disease, asthma, bronchiectasis.
  • Urgent care sensitive conditions: COPD, acute mental health crisis, non-specific chest pain, falls (aged 74 and over), non-specific abdominal pain, deep vein thrombosis, cellulitis, pyrexial child (aged 6 years and under), blocked tubes, catheters and feeding tubes, hypoglycaemia, urinary tract infection, angina, epileptic fit, minor head injuries.

This work uses data provided by patients and collected by the NHS as part of their care and support. Read more on our website.

Office for National Statistics population estimates were used to calculate rates of emergency admissions. 

International indicators:

Definitions and comparability for the international indicators are taken directly from the OECD report Health at a Glance 2021: OECD indicators. Detailed information about the definitions and the source and methods for each country can be found here.

The asthma and COPD indicators are defined as the number of hospital admissions with a primary diagnosis of asthma or COPD among people aged 15 years and over per 100,000 population. Rates are age-sex standardised to the 2010 OECD population aged 15 and over. Admissions resulting from a transfer from another hospital and where the patient dies during the admission are excluded from the calculation as these admissions are considered unlikely to be avoidable.

Diabetes avoidable admission is based on the sum of three indicators: admissions for short-term and long-term complications and for uncontrolled diabetes without complications. The indicator is defined as the number of hospital admissions with a primary diagnosis of diabetes among people aged 15 years and over per 100,000 population. Rates were directly age-sex standardised to the 2010 OECD population.

Differences in data definition and coding practices between countries may affect the comparability of data. For example, coding of diabetes as a principal diagnosis versus a secondary diagnosis varies across countries. This is more pronounced for diabetes than other conditions, given that in many cases admission is for the secondary complications of diabetes rather than diabetes itself. 

One of the main problems with these indicators is that they look only at hospital admissions and do not take account of differences in disease prevalence. For example, with regard to diabetes, it is not clear whether lower admission rates are due to a lower prevalence of diabetes in the population or better management of people with diabetes.

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