Burden of recurrent emergency hospital admissions in children and young people in England: a cohort study

Abstract

BackgroundIn England, the number of emergency admissions in children and young people has increased by 28% since 1999. Evidence is lacking about the contribution of recurrent admissions to the high rate of emergency admissions among children and young people. We quantified the contribution of recurrent admissions to the total burden of admissions in England. MethodsWe analysed all hospital admissions to the National Health Service in England using Hospital Episode Statistics from 2009 to 2011 for children and young people aged 0–24 years. We followed up children and young people for 2 years from their first emergency admission (index admission) in 2009. We determined the number of subsequent admissions, time to next admission, length of stay, and the proportion of admissions for injury and of children affected by a chronic condition measured by diagnostic codes in all admissions during the 2 years. Findings869 895 children had an index admission in 2009, resulting in a further 939 710 admissions (of which 600 322 [64%] were emergency admissions) over the next 2 years. We excluded 4371 children (0·5%) with inconsistent records (eg, multiple birth admissions). After discharge from the index admission, 274 986 children (32%) had a recurrent emergency admission, accounting for 41% (n=1 470 107) of all emergency admissions in the 2-year cohort. A few children and young people (37 311, 4%) had four or more emergency admissions. The proportion of patients with recurrent admissions was similar across all age groups. 73 830 first recurrent admissions (26%) occurred within the first month after discharge from the index admission. 360 633 index admissions (41%), in contrast with 459 167 recurrent emergency admissions (76%), were in patients with a chronic condition. InterpretationThis snapshot of hospital flow during 2 years shows that recurrent emergency admissions account for a substantial minority of all emergency admissions and predominantly affect children and young people with chronic conditions. Since we only included inpatient hospital data, our analysis provides a limited overview of health-care use. Interventions to reduce re-admissions should consider discharge planning for support by community services for parents caring for children with chronic conditions. FundingLW was supported by funding from the Department of Health Policy Research Programme through funding to the Policy Research Unit in the Health of Children, Young People and Families. This is an independent report commissioned and funded by the Department of Health.