Comparison of Attendance and Emergency Admission Patterns at Accident and Emergency Departments in and out of London

Objective: To compare the sociodemographic characteristics, diagnoses, and mode of referral of people and emergency admissions between an accident and emergency department in inner London and one in a town outside London.

Design: Standardised questionnaire completed prospectively over two weeks by field-workers in each accident and emergency department.

Setting: Accident and emergency departments in an inner London teaching hospital and an associated teaching hospital outside London.

Subjects: 3039 adults newly attending the departments, 1476 in inner London and 1563 outside London.

Main Outcome Measures: Sociodemographic characteristics, diagnosis, mode of referral, and whether the patient was admitted.

Results: General practitioner referrals accounted for similar proportions of the adult attendances (12% in inner London, 15% outside London). People attending at the inner London department were more likely to be tourists or long distance commuters (12% (179/1476) v 6% (95/1563)), single (43% (643) v 32% (505)), to live alone (24% (360) v 14% (225)), to have moved recently (13% (194) v 7% (107)), or to be homeless (3.3% (48) v 0.6% (10)). Broad clinical groupings of patients were similar in both departments. 291 people were admitted in inner London and 284 outside London. The proportions admitted from each sociodemographic group were similar in the two hospitals.

Conclusion: Differences in sociodemographic characteristics were more important than general practice referral patterns in determining the differences in people attending at accident and emergency departments inside and outside London. Many of these characteristics are likely to be found in other inner city populations. A strategy to improve acute care in inner London should take account of the needs of these sociodemographically different groups.