Reducing avoidable emergency admissions

This healthcare insight report details an extensive analysis of avoidable emergency admissions over a five-year period, and in doing so highlights a number of actions that can be taken towards preventing them | Dr Foster

This report looks specifically at ambulatory care sensitive conditions (ACSCs), which can be managed or prevented through effective primary and community care. ACSCs can be chronic conditions where early intervention can help prevent exacerbation; acute conditions where early intervention can prevent progression; or conditions where immunisation can prevent disease.

The report paints a startling picture of avoidable emergency admissions, finding that the admission rate increased by nine per cent over the analysis period, even after adjusting for population growth.

The report reveals which conditions patients are most likely to be admitted for in an emergency, who those patients may be, and the impact of deprivation. It takes an in-depth look at the possible savings to be made across both sustainable transformation partnerships (STPs) and clinical commissioning groups (CCGs) in England, estimating combined potential savings of £125 million.

Full report: Reducing avoidable emergency admissions. Analysis of the impact of ambulatory care sensitive conditions in England.

The role of volunteers in ambulance services

This report explores the role and value of volunteering within ambulance services in England and identifies examples of different ways in which volunteering opportunities are being developed | Kings Fund


The role of volunteers within ambulance trusts is well-established, largely focusing on two key areas of provision – community first responder schemes and non-emergency patient transport services.

However, ambulance trusts are now taking steps to develop and diversify volunteering within their services, from improving recruitment and management, to developing new activities and roles to meet changes in demand and building relationships with communities.

The report concludes by highlighting some key lessons for future development of the role of volunteering in ambulance services and identifies some important next steps to ensure a more strategic approach that realises the potential of volunteers.

Full report: Volunteering in ambulance services: developing and diversifying opportunities

See also: Saving lives, supporting communities: The role of volunteers in ambulance services

Same day emergency care

NHS Improvement| April 2019 | Same day emergency care

NHS Improvement have produced a new section on its website relating to same day emergency care along with links to relevant resources. Same day emergency care (SDEC) is one of the many ways the NHS is working to provide the right care, in the right place, at the right time for patients.

The resources are available from NHS Improvement’s website 

Effectiveness of Treatments and Diagnostic Tools and Declining Mortality in Patients With Severe Sepsis: A 12-Year Population-Based Cohort Study

Chen, K. F., Tsai, M. Y., Wu, C. C., & Han, S. T. |2019| Effectiveness of Treatments and Diagnostic Tools and Declining Mortality in Patients With Severe Sepsis: A 12-Year Population-Based Cohort Study| Journal of intensive care medicine|0885066619827270.

The Journal of Intensive Care Medicine has published the findings of a study that looks at the effectiveness of treatments and diagnosis tools on patients with severe sepsis. 


Sepsis is a major cause of morbidity and mortality worldwide. With the advance of medical care, the mortality of sepsis has decreased in the past decades. Many treatments and diagnostic tools still lack supporting evidence. We conducted a retrospective population-based cohort study with propensity score matched subcohorts based on a prospectively collected national longitudinal health insurance database in Taiwan. Severe sepsis-associated hospital admissions from 2000 to 2011 based on International Classification of Diseases, Ninth Revision, Clinical Modification codes of infections and acute organ dysfunction were identified. To compare the effectiveness of treatment and diagnostic tool, propensity scores were generated to match the comparable control groups. During the 12-year period, 33 375 patients and 50 465 hospitalizations of severe sepsis were identified. The age-standardized 28-day in-hospital mortality decreased significantly from 21% in 2008 to 15% in 2011 with increasingly implemented treatment and diagnostic tool. After propensity score matching, procalcitonin and lactate testing, transfusion of packed red blood cell, albumin, balanced crystalloid, and use of dopamine  were found to be significantly associated with lower mortality rate. However, inconsistent findings need to be further validated.

Rotherham NHS staff can request the article from the Library & Knowledge Service 


Waiting Times and Attendance Durations at English A&E Departments

The Strategy Unit & NHS Midlands and Lancashire Commissioning Support Unit | February 2019 | Waiting Times and Attendance Durations at English A&E Departments

A new report from The Strategy Unit presents a detailed view of presents a detailed review of the demand-side, supply-side, practice and emergent factors that lead to 4-hour breaches with a particular focus on changes that have taken place since 2010.


Waiting Times and Attendance Durations at English A&E Departments reviews both commonly cited causal factors and a range of more novel hypotheses.  It sets out the causal theories underpinning each factor and seeks statistical evidence in support of them.  Finally, the analysis scales the relative impact of each causal factor and aims to provide an explanation for the recent deterioration in A&E waiting times within the limits of national datasets.  New insights emerge which have the potential to reshape the received wisdom about the performance of A&E departments, carrying important implications for healthcare policy and system leadership (Source: The Strategy Unit).

Waiting Times and Attendance Durations at English Accident and Emergency Departments

Clinical guidelines for major incidents and mass casualty events

NHS England | January 2019 | Clinical guidelines for major incidents and mass casualty events

This guidance has been developed on behalf of the NHS to establish and share best practice in the clinical management of major incidents and mass casualty events, using experience from both military and civilian practice and lessons identified after the recent incidents, and to assist clinicians in managing these patients.

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The intention is that this guidance will be regularly reviewed and re-issued as new developments based on an ever-increasing evidence base and experience emerge (Source: NHS England).

Nearly 50 per cent of sport injuries treated in A&E are in kids

University of Newcastle| November 2018 |Almost half of sport injury-related A&E attendances are children

New research indicates that children under the age of eighteen are the highest burden of sports-related injury to A&E. With 12 year-old females, and 14-year-old males being the most at risk of sustaining a sports injury. The research involved analysis of injury attendance data at two hospitals, one in Oxford and the other in Banbury, from January 2012 – March 2014. Attendances recorded totalled almost 64,000 (63,877), of these  11,676 were sport-related, with 5,533 of these in  children and young people aged 0-19.

The research conducted by researchers at the University of Newcastle and University of Oxford, found the most injurious sports activities for girls were trampolining, netball and horse riding; for boys this was rugby union, rugby league and football.


Graham Kirkwood, senior research associate at Newcastle University, said: “These figures are equivalent to 68 boys and 34 girls in every thousand attending NHS emergency departments in a year. This is a heavy burden on the NHS and on children and families from sport-related injury.”

He added: “Children need to be physically active but making organised sports as safe as possible needs to be part of any effective child obesity strategy.” (Source: University of Newcastle)

Full news release at the University of Newcastle

The full article is available to read at Journal of the Royal Society of Medicine 

To analyse and report on sports-related injuries using enhanced injury data collected by the testbed for the NHS emergency care injury data set and admissions data collected from inpatients.


Ecological study design.

Two Oxfordshire NHS England hospitals.

Emergency department attendees and inpatients aged 0–19 years with sports injuries.

Data were analysed from 1 January 2012 to 30 March 2014 by age, gender sport, injury location, injury mechanism and diagnosis including concussion/post-concussion, bone fractures and ligament damage. Admissions data were analysed from 1 January 2012 to 24 January 2015.


Children and adolescents aged 0–19 years accounted for almost half (47.4%) of sports injury-related emergency department attendances and almost one-quarter (23.5%) of sports injury-related admissions for all ages. The highest rates of attendance occurred at 14 years for boys (68.22 per 1000 person-years) and 12 years for girls (33.72 per 1000 person-years). For male 0–19-year-olds the three main sports were (in order) football (soccer), rugby union and rugby league and for females, trampoline, netball and horse-riding. The largest gender differences were in netball where injuries were predominantly in females and in wheeled motorsports where injuries were predominantly in males. Almost one-quarter of emergency department sports-related injuries recorded were fractures, the highest percentage to the upper limbs.


Public health departments in local authorities and schools should consider target sports injury prevention at children in the first four years of secondary school. For younger age groups, trampolines in the home warrant improved safety. Rugby and horse-riding should also be a focus for interventions.

Full reference: Kirkwood, G., Hughes, T. C., & Pollock, A. M. |2018 | Results on sports-related injuries in children from NHS emergency care dataset Oxfordshire pilot: an ecological study|Journal of the Royal Society of Medicine|

In the media:

BBC News Children and adolescents ‘account for half of sports A&E attendances’