Non-admission or non-invitation? A case-control study of failed admissions

Abstract

OBJECTIVE--To examine the causes of non-admission to hospital. DESIGN--Validation of published rates of non-admission by examination of medical records, followed by a case-control study of non-attenders (cases) and attenders (controls). SETTING--General hospital. SUBJECTS--246 Patients (cases in the case-control study) booked for admissions in four specialties (general surgery, gynaecology, otorhinolaryngology, and trauma and orthopaedics) during April, May, and June 1987 who were not admitted for reasons that seemed to be attributable to the patients. Controls comprised 167 patients admitted to the same specialty on the same day. RESULTS--The validation of administrative records indicated that it is unusual for patients to fail to present for admission without advising the hospital beforehand; this occurred in only 1-3% of all bookings. Information on the circumstances of non-admission and clinical and personal details were collected by means of a six page questionnaire completed by the patients. The case-control study showed that those not admitted were younger and had been on the waiting list longer. Otherwise only small differences were found in the social and clinical characteristics. CONCLUSIONS--Despite a common tendency to blame patients for non-admission, factors due to patients are fairly unimportant.