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Neither local case mix, primary care provision nor geography explains the large differences in hospital admission rates, ranging from less than 10% to more than 40%, from emergency departments across England, finds research published online in Emergency Medicine Journal.

The findings imply that locally tailored strategies, which take account of local resources, such as urgent care facilities and transport options, may more effectively reduce unnecessary admissions than uniform national policies, say the researchers.

The growth in hospital admissions from the emergency department has become an international concern due to its impact on costs, hospital crowding and potential readmissions, explain the researchers.

But rather than focusing on identifying predictive factors, which many previously published studies have done, the researchers wanted to understand the variation in these admission rates once local area characteristics had been accounted for.

They used national anonymized data on emergency care and admissions for hospitals across England for the year 2024–25 to measure the variation in the likelihood of a patient being admitted from an emergency department.

They adjusted for local case mix, visits (method of arrival; primary reason for seeking emergency care), geography and general practice characteristics (access; workforce availability per 1,000 patients; quality of care; availability of alternative urgent care facilities).

After exclusions due to missing patient and primary care provider information, the data analysis was based on 15,201,063 emergency department visits.

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