1. Assessing the seasonal impact of tourism on emergency hospital admissions in the South West Paul Brown 2, Julia Verne 2, Roy Maxwell 1,2, Caroline Trotter 1,2, Davidson Ho 1,2, Mark Dancox 2, www.swpho.nhs.uk Figure 1: Seasonal pattern of emergency admissions in the South West Data source: Hospital Episode Statistics Figure 2: Seasonal pattern of emergency admissions in the South West – non residents Data source: Hospital Episode Statistics Figure 3: Location of Royal Cornwall and Gloucestershire Foundation Trust hospitals Figure 4: Gloucestershire v. Cornwall Emergency admissions, 2002/03 Data source: Hospital Episode Statistics 1Department of Social Medicine, University of Bristol 2South West Public Health Observatory, Bristol South West Public Health Observatory Background The South West Region is the most popular destination for domestic visitors, estimated at 23 million domestic visits in 2003, comprising of a mixture of business trips, family visits, & holidays. Within the region, Devon & Cornwall are the most popular counties, accounting for approximately half of those domestic visits (Source: South West Tourism, 2003). Aims To devise & test a robust measure for defining which emergency admissions to hospital were to visitors/tourists. To assess the seasonal impact of tourism on emergency hospital admissions in the South West. Methods and results Hospital Episode Statistics (HES), made available by the NHS Health and Social Care Information Centre, were used to assess the impact of visitor emergency admissions to hospitals in the South West according to: region of residence i.e. did the patient live in the South West? distance i.e. did the patient live within 150 km of the hospital they were admitted to? Fig 1 shows that, overall, emergency admissions increased over time i.e. year-on-year, in the South West; a pattern also reflected in emergency admissions for residents. A clear seasonal pattern emerges for non-residents, with increased emergency admissions in the summer months. Fig 2 illustrates this pattern more clearly. Non-residents account for approximately 5% of emergency admissions each year. Fig 3 shows the geographical position of the two largest trusts in the region used in the ‘150km distance group’ analysis: the Royal Cornwall Trust, and the Gloucestershire Foundation Hospital Trust. Fig 4 compares results for the ‘150km distance group’ and the ‘non- resident group’. The distance from the regional boundary suggests that for the Royal Cornwall Trust (red) either measure may be used. However, in Gloucestershire the two methods produce substantially different results, with the distance method (green columns) estimating fewer admissions overall with peak admissions occurring in the summer, compared to the non-resident method (green line) which estimates a peak in visitor emergency admissions during the autumn. The proximity to Wales, the West Midlands, & the South East suggests that the ‘distance’ method is likely to produce more reliable estimates, although the ‘cut-off’ distance may need to be revised downwards according to available local information. Conclusions The impact of visitor emergency admissions is variable, & accurate assessment is dependent on the measure used. Distance between actual place of residence & place of treatment is intuitively a more sensitive measure with the advantage that ‘actual’ distance may be varied according to needs. In reality the optimum cut-off distance may vary from hospital to hospital. Region of residence is a relatively crude measure for defining who is a ‘visitor’: an individual might live within one region, yet reside within the catchment area of a hospital located in an adjacent region. Visitors are vital for the local economy, but without sufficient planned healthcare provision there is the risk that large seasonal increases in visitor numbers may adversely affect the availability of healthcare for residents.