Admission avoidance

Emergency hospital admissions while on an elective waiting list in England: an observational study using administrative data (2026)

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Type of publication:

Journal article

Author(s):

James, Anthony P; Gray, William K; *Cheetham, Mark J; Eardley, Ian; Lansdown, Mark.

Citation:

British Journal of Surgery. 113(2), 2026 Feb 11.

Abstract:

INTRODUCTION: Patients awaiting elective procedures often have conditions that carry a risk of medical emergencies. This study quantifies the extent and variation of emergency hospital admissions during the waiting period across selected specialties and procedures.

METHODS: Data from the NHS England Waiting List Minimum Dataset linked to the Secondary Uses Service hospital admissions data set from 1 January 2022 to 31 December 2023 was analysed. Emergency admissions occurring while patients awaited treatment were identified and categorized from 'very likely' related to the index condition or its recognized co-morbid risks-and potentially avoidable through definitive treatment-through to 'unrelated'.

RESULTS: In 2023 some 2 093 789 waits (both incomplete and complete) were recorded across 41 selected procedures spanning 11 specialties. Over a combined waiting time of 33 832 790 days, 69 322 emergency admissions occurred, accounting for 535 806 bed days. The highest emergency admission rates per 52 weeks waiting were observed for urinary stent procedures (0.71), endoscopic retrograde cholangiopancreatography (0.63), and urinary catheter care (0.55). Nine procedures had more emergency bed days during the wait than elective bed days post-treatment, with the highest emergency/elective bed day ratios for ureteric stones (4.59), colonoscopy (2.80), and ablation/cardioversion (2.05).

CONCLUSION: A substantial number of patients on elective waiting lists are being admitted as emergencies during their wait, placing a burden on emergency care that would be avoided through more timely treatment. The variation in risk between specialties and pathways requires further prioritization strategies that mitigate patients' risk of associated harm, acting both within and across waiting lists, specialties, and organizations.

DOI: 10.1093/bjs/znaf292

Can Improving Working Partnerships with Primary Care Prevent Avoidable Emergency Admissions for Patients with Lung Cancer? (2018)

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Type of publication:
Conference abstract

Author(s):
Morley J.; Anderson V.; Beattie V.; Clayton K.; Denby D.; Eaton M.; Glover S.; Griffiths A.; Maddock N.; *McAdam J.; Morgan S.; Rees P.; Perkins T.; Phillips S.; Pugh B.; Roberts J.; Robinson W.; Rose P.

Citation:
Journal of Thoracic Oncology; Oct 2018; vol. 13 (no. 10)

Abstract:
Background: A literature search was performed. Primary Care Professionals (PCP'S) and National Lung Cancer Forum for Nurses (NLCFN) members were surveyed. Patients with a known diagnosis of lung cancer and their carers were interviewed following emergency care admissions. Lung Cancer Nurse Specialists (LCNS) from 15 NHS Trusts/Health Boards (HB) throughout the United Kingdom participated in data collection between May and August 2017. Method: A literature search (CINAHL, Embase, Proquest, PubMed, Medline) was performed. 120 PCP's from 7 CCG's/HB were surveyed to ask how and why they would contact a LCNS; any difficulties experienced contacting a LCNS and what support the LCNS could provide. 86 (72%) responded. 27 patients and their carers from 5 NHS/HB who were admitted as an emergency with a symptom related to their lung cancer were interviewed by a LCNS. A questionnaire was sent to all NLCFN members, asking "What do you do in your current practice to help prevent avoidable emergency hospital attendances?" Result: There was no published literature specific to the project aim. 46 (53%) PCP's knew how to contact the LCNS, 24 (28%) did not and 16 (19%) were unaware the service existed. PCP's reported that the LCNS could improve communication and provide education and specialist advice to help reduce avoidable emergency admissions. Following review by the LCNS, 25 (92%) of emergency admissions were deemed necessary. 2 (8%) patients contacted 999, with the rest seeking advice from the LCNS, Acute Oncology Service or GP prior to admission. 282 NLCFN members were surveyed with 59 respondents. Findings highlighted wide variations in practice, although a number of common themes were evident. Proactive communication with patients and HCP's and timely referrals and signposting were key to identifying and addressing potential problems as early as possible. Conclusion: This small data sample suggests that patients were admitted appropriately. The NLCFN survey highlighted the role of the LCNS in providing expert specialist knowledge and advice to patients and Health Care Professionals throughout the patients journey. PCP's expressed that they would like to know more about the role of the LCNS and would value better means of communication, advice and specialist support to improve patient care.