I analyse an anonymised data dump of 1.9 million admissions records to the emergency departments of an undisclosed NHS Trust for the period June 2017 – September 2021
The obvious retort (which is a stretch for me btw!) is that since number of deaths is always small cf admissions, if you closed down the NHS and told people to stay away EXCEPT for very seriously ill patients - isn't this what you would see as a result of the "pandemic" infecting people all of a sudden?
In other words, this could still be new patients coming in rather than existing patients who die, as you imply?
(Playing devil's advocate here to an extent of course.)
Yes indeed, funnelling is very likely and we probably have a mix of these incoming plus those already incarcerated. Given the lion's share of A&E treatments are usually doing not a lot or giving guidance only then the case profile would have swung dramatically. Folk I know preferred to treat themselves at home!
My analysis of deaths and midazolam use for 7 NHS trusts shows the first peak in deaths at 10/4/20 close to your 5/4/20. Second peak at 22/1/21. The peaks in midazolam scripts were 31/4/20 and 31/1/21. The drug data was month-end versus weekly for deaths.
Could A&E admissions be a bad proxy for hospital admissions? By that I mean only sickest come in, so the hospital admission rate could be high, thereby putting demand on hospital beds, but not A&E. Pretty sure we've been there already, but just another devil's advocate.
Under normal circumstances then yes, A&E admissions wouldn't correlate that well with elective admissions. During lockdown elective admissions were minimal such that A&E became the feed to the wards. Thus we've got a mixed bag of effects that phase in and out over time.
Tricky to say because we're looking at all cause death in any part of the Trust against admissions via A&E and not admissions in general. Some of these deaths may have come in through A&E but I suspect most were in-patients.
Another confounding factor is avoidance of hospitalisation by less sick folk. Linked to this are deaths in direct response to lockdown (suicide, intoxication, risk taking behaviours).
All admissions vs. all deaths would help clarify the situation, as would A&E admissions vs. A&E deaths. Then there's breaking deaths down into categories in an attempt to pinpoint cause - all of this will be coming up as a set of time series apart from all admissions since I don't have that data.
What you call the ED is what we call A&E, being the single first point of registration for all non-elective admissions, be they a kid with a toy in their ear or a gunshot victim. In my hospital this was a waiting room, a triage suite of cubicles, a mini-ward with areas that can be curtained for modesty and then the resus zones for the serious stuff. Our ICU was a separate facility run by general medicine, with the CICU run by cardiac services. Blue light cases were triaged through A&E then trolleyed to ICU/CCU/CICU accordingly.
The obvious retort (which is a stretch for me btw!) is that since number of deaths is always small cf admissions, if you closed down the NHS and told people to stay away EXCEPT for very seriously ill patients - isn't this what you would see as a result of the "pandemic" infecting people all of a sudden?
In other words, this could still be new patients coming in rather than existing patients who die, as you imply?
(Playing devil's advocate here to an extent of course.)
Yes indeed, funnelling is very likely and we probably have a mix of these incoming plus those already incarcerated. Given the lion's share of A&E treatments are usually doing not a lot or giving guidance only then the case profile would have swung dramatically. Folk I know preferred to treat themselves at home!
Where do you see new patients coming in?
My analysis of deaths and midazolam use for 7 NHS trusts shows the first peak in deaths at 10/4/20 close to your 5/4/20. Second peak at 22/1/21. The peaks in midazolam scripts were 31/4/20 and 31/1/21. The drug data was month-end versus weekly for deaths.
Link?
Hi John, may I request again that you include a short summary of your conclusions at the beginning of each essay?
Could A&E admissions be a bad proxy for hospital admissions? By that I mean only sickest come in, so the hospital admission rate could be high, thereby putting demand on hospital beds, but not A&E. Pretty sure we've been there already, but just another devil's advocate.
Under normal circumstances then yes, A&E admissions wouldn't correlate that well with elective admissions. During lockdown elective admissions were minimal such that A&E became the feed to the wards. Thus we've got a mixed bag of effects that phase in and out over time.
The all-cause deaths/admissions chart tells us everything we need to know, but I think my interpretation is different from yours.
Can you clarify what you think that shows?
Thanks.
Tricky to say because we're looking at all cause death in any part of the Trust against admissions via A&E and not admissions in general. Some of these deaths may have come in through A&E but I suspect most were in-patients.
Another confounding factor is avoidance of hospitalisation by less sick folk. Linked to this are deaths in direct response to lockdown (suicide, intoxication, risk taking behaviours).
All admissions vs. all deaths would help clarify the situation, as would A&E admissions vs. A&E deaths. Then there's breaking deaths down into categories in an attempt to pinpoint cause - all of this will be coming up as a set of time series apart from all admissions since I don't have that data.
A&E = ?
Accident & Emergency - I forget you are across the pond!
What is an accident that doesn't go through the ED? Direct admit to ICU?
What you call the ED is what we call A&E, being the single first point of registration for all non-elective admissions, be they a kid with a toy in their ear or a gunshot victim. In my hospital this was a waiting room, a triage suite of cubicles, a mini-ward with areas that can be curtained for modesty and then the resus zones for the serious stuff. Our ICU was a separate facility run by general medicine, with the CICU run by cardiac services. Blue light cases were triaged through A&E then trolleyed to ICU/CCU/CICU accordingly.
Yes, that is consistent with what occurs here.
But March 2020 saw some...rearranging...