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HCAF have discovered a 3 to 8 (average around 6) year  repeating pattern in emergency medical admissions which is international in scope, age, gender and diagnosis specific and shows a spatial spread consistent with an infectious outbreak.

 

It is possible that the ubiquitous herpes virus, cytomegalovirus (CMV) may be directly or indirectly involved, although this will require significant new research to validate. A review of the mechanisms by which CMV could cause such outbreaks, especially in the elderly, is due for publication around March 2012.

 

This groundbreaking work has profound implications to all aspects of commissioning, hospital capacity planning and the funding of health services.

 

 

 

   Emergency Admissions

 

 

 

 

  Documents

 

Trends & cycles in emergency admissions

Increase in emergency admissions - trend or step change?

Additional studies

A new infectious disease?

A cycle of surplus & deficit, or a new immune disease?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please note that draft versions of the papers are for browsing. The final published article may be different to the draft. Please obtain a copy from your library or institutional login.

 

BJHCM articles are available from www.bjhcm.co.uk

 

Those who work in the NHS can use their Athens login to access articles on the BJHCM website.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
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There are considerable misconceptions about emergency admissions. Many claim them to be predictable, i.e. implying precision or certainty. The link between the weather and environment (air quality, viral & other infectious outbreaks) creates the opportunity for emergency admissions to show highly erratic trends over time, i.e. while there may be general seasonal and day of week patterns the upper and lower limits around the average are widely spaced.

 

The financial risk associated with emergency admissions is up to 3-times higher than due to chance variation alone. There are considerable implications to the longer-term bed requirements of hospitals, to commissioning and financial risk in GP commissioning. These issues are covered in the 'Financial Risk' folder.

 

HCAF has discovered that the international trend to higher than expected medical admissions, which has been ongoing for the last 40 to 50 years, is made up from a repeating pattern of step-like increases occurring at three to eight year intervals. It is these steps rather than the trend between the steps which is dominating growth and patterns in the total costs of health care.

 

Additional cycles appear to apply for trauma admissions (mostly weather-related) and the economic cycle has also been shown to influence psychological and general health and leads to unexplained counter-cyclic changes in the mortality rate. It is becoming increasingly clear that health care costs behave in ways that simple demographic forecasts can never predict.

 

These findings are of immense practical significance and greatly affect the pattern of costs over time. Contact Dr Rod Jones to discuss the implications to PCT and CCG commissioning. hcaf_rod@yahoo.co.uk

 

Emergency Admissions Series

 

British Journal of Healthcare Management (BJHCM)

 

Jones R (1996) Estimation of annual activity and the use of activity multipliers.

    Health Informatics 2: 71-77

Jones R (1997) Emergency admissions: Admissions of difficulty.

   Health Service Journal 107(5546): 28-31 Read Me

Jones R (2009) Trends in emergency admissions. BJHCM 15(4): 188-196   Read Me

Jones R (2009) Cycles in emergency admissions. BJHCM15(5):  239-246   Read Me

Jones R (2009) Emergency admissions and hospital beds. BJHCM 15(6): 289-96  Read Me

Jones R (2009) Emergency admissions and financial risk. BJHCM 15(7): 344-350  Read Me

Jones R (2010) Cyclic factors behind NHS deficits and surpluses. BJHCM16(1): 48-50  Read

Jones R (2010) Emergency preparedness. BJHCM16(2): 94-95   Read Me

Jones R (2010) Unexpected, periodic, increase in medical inpatient care: Man-made or new disease?

   Medical Hypotheses 74(6): 978-983  Read Me

Jones R (2010) Can time-related patterns in diagnosis for hospital admissions help identify common root causes for disease expression? Medical Hypotheses 75(2): 148-54  Preview or Read Me

Jones R (2010) The case for recurring outbreaks of a new type of infectious disease across all parts of the United Kingdom. Medical Hypotheses 75(5): 452-457  Preview or Read Me

Jones R (2010) The nature of health care costs and financial risk in commissioning.

    BJHCM 16(9): 424-430  Read Me

Jones R (2010) Forecasting emergency department attendances.

    BJHCM16(10): 495-496  Read Me

Jones R (2010) Trends in programme budget expenditure. BJHCM16(11): 518-526  Read Me

Jones R (2010) Gender ratio and hospital admissions. BJHCM 16(11): 541  Read Me

Jones R (2010) A fair tariff for emergency assessment activities - lessons learned.

    BJHCM 16(12): 574-583  Read Me

Jones R (2011) Impact of the accident and emergency target in England.

    BJHCM 17(1): 16-22  Read

Jones (2011) Infectious outbreaks and the NHS Capitation Formula.

    BJHCM 17(1): 36-38  Read Me

Jones R (2011) Costs of paediatric assessment. BJHCM 17(2): 57-63  Read Me

Jones R (2011) Cycles in inpatient waiting time. BJHCM 17(2): 80-81  Read Me

Jones R (2011) Cycles in gender-related costs for long-term conditions.

    BJHCM 17(3): 124-125  Read Me

Jones R (2011) Cytomegalovirus (CMV) and health care costs.

    BJHCM 17(4): 168-169  Read Me

Jones R (2011) Unanswered questions from the trends in international bed occupancy.

    BJHCM 17(7): 307-313  Read Me

Jones R (2011) Volatility in bed occupancy for emergency admissions.

   BJHCM 17(9): 424-430. Read Me

Jones R (2012) Time to re-evaluate financial risk in GP commissioning.

   BJHCM  18(1): 39-48  Read Me

Jones R (2012) Could Cytomegalovirus be causing widespread outbreaks of chronic poor health?  In 

   Hypotheses in Clinical Medicine, Eds M. Shoja et al, New York: Nova Science Publishers, Inc (in press, due approx Mar 2012)

Jones R (2012) Environment induced volatility and cycles in population health. Positive Health (in press)

 

 

 

 

 

 

 

 

 

  Refer to 'Forecasting Demand' 

  folder for studies relating to the

  evaluation of excess demand

  and the 'Hospital Beds' folder

  for issues relating to emergency

  admissions and bed requirements.