26Admitting a patient to hospital as an emergency is an important aspect of General Practice care. Oftentimes a patient is admitted with seemingly dramatic symptoms only to be discharged well the next day. Hospital doctors have rapid access to diagnostic tests and may be able to quickly rule out serious illness and this is one good reason we admit patients. It is difficult therefore to make an objective measure of when it is appropriate to admit a patient to hospital, as the GP is often put in a position of needing to admit to rule out a serious condition.

The following table may help you to examine the reasons that you admit a patient to hospital and may highlight issues for discussion. Try to analyse your next 10 emergency admissions.  You may wish to include your reflections on the issues identified and learning points on the appraisal online form 3 template, and include your analysis as additional supporting documentation.

docxEmergency Admissions Template

 Are there any issues raised by the 10 cases above?

 Are any learning needs highlighted?

 docxEmergency Admissions Example

Are there any issues raised by the 10 cases above?

These 10 cases took 16 working days to collect including one evening session in the OOH (admittedly a “base” session). I also note that most admissions were late morning/early afternoon – this must place great strain on hospital admissions unit. I think all admissions were appropriate despite negative findings in many of the cases. The one case that struck home was the lady with the metastatic bowel Ca, she had lost symptom control and had been feeling unwell for 3 days before she called me. She had not wanted to bother the doctor or the palliative care nurse involved in her care

Are any learning needs highlighted?

We discussed the lady with the pain at our multidisciplinary team meeting and highlighted the issue around her not wanting to bother us – she had been OK when seen 1 week prior to admission and a further visit was planned a week later. The upshot of the meeting was that there was not much that could have been done as it is always stressed to patients that they can contact either the surgery or the palliative care team at any time. We reviewed the information supplied to patients by the palliative care team and this strongly reinforces that message. The other issue is the gastric ulcer probably related to meloxicam – I understood that this was a cox 2 inhibitor and therefore safer than traditional NSAIDS however when I looked this up I discovered that NICE advocates their use in older patients but that recent evidence in the BMJ http://bmj.bmjjournals.com/cgi/content/full/331/7528/1310  casts doubt on this. I will consider this more carefully in future.