Increasing demand on emergency departments

There is ongoing and often heated debate about the causes of increasing demand on emergency departments. Michael Dinh and colleagues (see page 708) from Sydney take a dispassionate look at the data to conclude that (in Sydney at least) increasing demand appears to be driven by the elderly presenting with acute problems requiring inpatient admission. I suspect this conclusion applies to many other health care systems.

But what is the solution? Lijun Fan and colleagues (see page 738) reviewed the effectiveness of interventions to reduce emergency department use by the elderly population and found that a number of community-based interventions reduced emergency department use. In contrast, some hospital-based interventions increased subsequent emergency department use. This leaves us in a tricky position. Should we develop services for the increasing number of elderly patients, knowing that this may attract even more attendances, or hope that community-based services will be …