The importance of emergency health care

Dr Rhona MacDonald, Freelance Editor rhonamacdonald@gmail.com

According to a report just published by the Nuffield Trust, the number of emergency admissions to English hospitals has been rising for some time and currently approximately 35 per cent of all hospital admissions in are classified as emergencies. The report, Trends in emergency admissions in England 2004 – 2009: is greater efficiency breeding inefficiency? estimates that emergency admissions cost the NHS £ 11 billion a year and that some of these admissions are frequently preventable and concludes thatthe rise has, in part, been caused by a lowering of the clinical threshold for emergency admissions – advances in medical care and management have reduced the length of time patients stay in hospital, which in turn has freed up more available beds and allowed doctors to admit more patients. The report argues that creating better out-of hospital care will allow expensive hospital beds to be closed.

I know that it is not always helpful to compare different health systems in different parts of the world but what really struck me when reading the report is just how fortunate countries that have efficient and well functioning health systems really are. Lack of emergency care is a massive problem in countries whose health systems are too weak to provide this crucial part of health care, resulting in many preventable deaths—rather more important than the preventable hospital admissions cited as a huge problem in the English report. However, because providing emergency care is no quick fix but involves building appropriate health systems and staff training, this vital area has been left off the international health agenda. So pregnant women continue to die of emergency conditions (thus slowing progress to MDG 5), children with pneumonia still die from lack of oxygen in the pre-hospital and hospital setting (hampering progress to MDG 4), and of course death from road traffic accidents, one of the leading causes of death in poorer countries, continue to soar.

According to the Nuffield report, about a third of English patients receive emergency care. Can you imagine what would happen if this option of care was not available to them? So surely it time that helping to enable countries to provide emergency care for their populations was placed nearer the top of the international community’s priority list.

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