Recent data briefings have presented trends in emergency admission rates per strategic health authority and the national picture remains very variable. This data briefing presents a case study from one trust and its experience of the practical issues in reducing such rates.

By continual service improvement in the medical service unit, Peterborough and Stamford Hospitals foundation trust has demonstrated no increase in emergency admissions and a sustained decrease in the length of stay for the elderly over the past two years.

In 2004-05, following a financial deficit and subsequent 'turnaround' push, there were 10,492 emergency admissions, which declined to 10,473 in 2005-06. For the same period, the length of stay in general medicine fell from 8.8 to 7.5 days and, in medicine for the elderly, was reduced from 10.5 to 8.7 days. There has been no corresponding increase in readmissions.

There is now a post in accident and emergency responsible for ensuring that patients who can be discharged are fully supported. This is further supported by integration of health and social care services within our main commissioning PCT.

The medical admissions unit has reorganised its patient flow, putting more emphasis on quicker investigations and decisions being made earlier in the patient journey. The team works to a self-imposed four-hour limit on decisions about whether to admit or discharge patients.

The ward linked to the medical assessment unit (MAU) has become short-stay, with patients needing more in-depth/specialist care moving to a specialty ward direct from the MAU whenever possible. This has been supported by all the medical consultants and ward managers in the form of daily ward rounds.

Targets have been set for all wards across the trust to ensure that 30 per cent of patients are discharged before 1pm and beds on wards become free earlier in the day.

Continual emphasis on well-documented care plans in multi-disciplinary patient notes and empowering nursing and junior medical staff to act on these have further reduced length of stay.

The overall impact of all the service improvement measures has been a reduction in bed capacity needed for medical patients. Coupled with similar experiences in surgery,
this has dramatically improved the financial position.

Dr Marc Farr is market development manager at Dr Foster Intelligence (phone 020 7256 4916) or visit The next Data Briefing from Dr Foster is on 8 March.